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CALIFORNIA LABOR COMMISSIONER'S OFFICE

Report of Labor Law Violation

Section 1. Reporting Party (Individual or Representative)

Fill out this form if you would like to report a widespread violation of workplace laws (e.g., wage and hour, child labor, workers’ compensation, or recordkeeping laws) by an employer that affects all or a group of employees working for the employer. If you are claiming only unpaid wages on behalf of yourself and do not wish to report a widespread violation of the law by your employer that also affects other workers, then fill out the DLSE Form 1 (Initial Report or Claim) http://www.dir.ca.gov/dlse/forms/wage/english.pdf to file an individual wage claim, instead of this form.
Reporting Party
If you are an ADVOCATE, or are represented by a lawyer or other advocate, enter your ADVOCATE and ORGANIZATION information:
Advocate Information

Section 2. Employer Reported

Work Locations
Add Another Work Location (if any, whether or not you worked there)

Section 3. Work Hours and Wages

What is the Normal or Standard Work Schedule for employees during the week? Provide your best estimate for the start and end times and number of hours worked for each work day. (If employees did not work standard schedules, skip to the next question.)
Enter all time in ##:## format, for example, 09:30, or 12:45
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

When is the normal or standard scheduled meal period for employees?
Such as Every 2nd Friday, or 1st and 15th of the month.

Section 4. Suspected Violations of Employer

The boxes below describe conduct by an employer that violates the law. Please put a check mark in the box(es) if the employer engages in, or any employee or employees have experienced, any of the following violations:
Minimum Wage Violations
Overtime Violations
Other Unpaid Wages
Pay Stub Violations
Meal Period Violations
Rest Break Violations
Pay Date Violations
Record Keeping Violations
Business Expense Violation
Failure to Post
Misclassification
Licensing / Registration Violations
Child Labor Violations
Please provide the following information for any minors under the age of 18 who work for the employer
Minor Employee
By check, in cash, both cash and check, or other method
Add another Minor Employee
* The Labor Commissioner will maintain confidentiality as appropriate in each case and to the extent provided for under the law. Information may need to be released in some cases.