Legal DLSE Notice

LEGAL DLSE NOTICE

This Notice is issued on by Claimant Name: and Respondent Name: (collectively the Parties). This Notice is issued in connection with a claim before the Division of Labor Standards Enforcement (DLSE) and is intended to provide formal notice of the allegations, requested relief, required compliance, and consequences of noncompliance described below.

RECITALS

WHEREAS, Claimant alleges that Respondent failed to pay wages, overtime, and other compensation owed under applicable wage and hour laws for the period beginning on through ; and

WHEREAS, Claimant has submitted a claim seeking unpaid wages, liquidated damages, penalties, reimbursement of business expenses, waiting time penalties, interest, and other relief permitted by law in an amount presently estimated to be $ (claimed amount subject to proof at hearing); and

WHEREAS, the Parties are required to exchange information and to appear for administrative conference or hearing as directed by the DLSE and to preserve records and evidence relevant to the claim.

NOW, THEREFORE

In consideration of the foregoing recitals and mutual covenants contained herein, the Parties agree as follows:

1. NOTICE OF CLAIM AND ALLEGATIONS

Claimant alleges that Respondent violated applicable wage and hour laws by failing to pay (select all applicable): Unpaid wages Overtime compensation Meal/rest period premiums Waiting time penalties Business expense reimbursement Other

Claim description and factual basis:

2. RELIEF REQUESTED

Claimant demands the following relief (enter amounts where applicable):

3. DEMAND TO APPEAR AND PRODUCE RECORDS

Respondent is directed to produce all payroll records, timekeeping records, personnel files, contracts, wage statements, commission calculations, and other documents reasonably related to the claim no later than or within days of receipt of this Notice, whichever is earlier. Production shall include records for the period from through .

4. SCHEDULED CONFERENCE/HEARING

A conference or hearing in this matter is scheduled for: Date: Time: Location:

Failure to appear as directed may result in a default determination and entry of relief as requested by Claimant, as permitted by law.

5. PRESERVATION OF EVIDENCE

Respondent must preserve all documents, electronic data, and tangible evidence relevant to the claims and defenses in this matter pending final resolution. Intentional destruction, alteration, or concealment of evidence may result in adverse evidentiary inferences and sanctions.

6. CONSEQUENCES OF NONCOMPLIANCE

If Respondent fails to comply with the production, appearance, or preservation obligations set forth herein, Claimant may seek administrative sanctions, an adverse inference, default judgment, assessment of statutory penalties, costs, and reasonable attorney's fees where authorized by law. The DLSE may take such measures as necessary to effectuate compliance.

7. NOTICES

Notices and communications required or permitted under this Notice shall be in writing and shall be delivered to the addresses provided below by personal delivery, certified mail, or other delivery method that provides proof of receipt. Notice is deemed given upon receipt.

8. GOVERNING LAW

This Notice and any enforcement proceedings arising from it shall be governed by and construed in accordance with the laws applicable to wage and hour claims and administrative enforcement as administered by the Division of Labor Standards Enforcement, without regard to conflict of law principles that would apply the laws of another jurisdiction.

9. ENTIRE AGREEMENT

This Notice constitutes the entire written notice of the matters set forth herein and supersedes any prior written notices concerning the same subject matter. No representation, promise, or inducement not reduced to writing in this Notice shall be binding upon any Party.

10. SEVERABILITY

If any provision of this Notice is held to be invalid or unenforceable by a tribunal of competent jurisdiction, the remaining provisions shall continue in full force and effect to the extent consistent with the original intent of the Parties.

11. AMENDMENT AND WAIVER

This Notice may be amended or modified only by a writing signed by the Parties. No waiver of any provision of this Notice shall be effective unless in writing and signed by the Party against whom the waiver is asserted.

12. COUNTERPARTS

This Notice may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Signatures delivered electronically or by facsimile shall be accepted for the limited purpose of evidencing assent to this Notice.

DLSE Case Number (if assigned):

Certification: By signing below, each signatory certifies under penalty of perjury under applicable law that the information provided in this Notice is true and correct to the best of their knowledge and that they are authorized to execute this Notice on behalf of the party for whom they sign.

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