WV-
150
INSTRUCTIONS FOR PETITIONS
TO PROHIBIT WORKPLACE VIOLENCE
Under California law (Code of Civil Procedure section 527.8), courts can make orders to
protect an employee from suffering unlawful violence or credible threats of violence. These
orders can be requested by the employer of a person who is suffering unlawful violence or
credible threats of violence, and will be enforced by law enforcement agencies.
The employer asking for these orders is called the ''plaintiff.'' The plaintiff needs to file a
petition in superior court, on behalf of his or her employee, against the other person
(''defendant'') to get these orders. There will be a court hearing within 15 days of the filing.
The plaintiff can sometimes get a temporary court order against the defendant even
before
the hearing.
This instruction booklet tells what court orders an employer can get and how to get them.
It also includes directions for a defendant who wants to oppose the employer's petition.
These instructions cannot cover all of the problems and questions that may arise in a
particular case. If you do not know what to do to protect your rights, you should see
an attorney.
Please note: These forms can be used only by an employer of a person who is suffering
unlawful violence or a credible threat of violence. If anyone other than the employer
wishes to apply to the court for an order prohibiting harassment, see the Judicial Council's
Instructions for Lawsuits to Prohibit Harassment (form CH-1 50).
Form Approved for Optional Use
Judicial Council of California
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GENERAL INFORMATION
Who can get a court order under this law?
This statute allows employers to obtain court orders
prohibiting unlawful violence or credible threats of
violence of their employees. The statute differs from
other California laws that allow victims of unlawful
violence or credible threats of violence to ask the court
for these orders themselves. To get an order under this
law, the plaintiff must be an employer. An employer is
defined as the following: What do you need to get the court orders or to object
to them?
1. Workplace violence forms, available from the county
clerk's office or legal publishers. The clerk of the court
can tell you where to get the forms.
2. Someone, other than yourself, 18 years of age or
older, to deliver (serve) certain papers to the other
part
y.
• Every person engaged in any business or enterprise
in this state that has one or more persons in service
under any appointment, contract of hire, or
apprenticeship, express or implied, oral or written,
irrespective of whether such person is the owner of
the business or is operating on a concessionaire or
other basis. (Lab. Code, § 350(a).) What forms are available for petitioning under the
workplace violence law and for opposing those
petitions?
1. Petition of Employer for Injunction Prohibiting Violence
or Threats of Violence Against Employee and
• A federal, state, or local public agency; a city,
county, district, or public corporation. (Code Civ.
Proc., § 527.8(d).) Application for Temporary Restraining Order [Petition]
(form WV-1 00). This three-page form tells the judge
the facts of the plaintiffs case and what orders the
plaintiff wants the court to make.
2. Order to Show Cause [OSC] and Temporary
Before completing the forms needed to obtain court
orders under this statute, make certain you meet the
definition of ''employer'' as stated.
Whom can an employer protect under this law? Restraining Order [TRO] (form WV-1 20). The OSC,
when signed by the judge, tells the defendant to come
to court for the hearing. It may include one or more
temporary restraining orders that take effect
immediately and stay in effect until the hearing.
Under this statute, employers can obtain court orders
which last up to three years on behalf of their employees
only and up to fifteen days on behalf of employees and
certain family or household members. California law
defines employees as: 3. Response to Petition of Employer for Injunction
• Every person, including aliens and minors, rendering Prohibiting Violence or Threats of Violence Against
Employee [Response] (form WV-1 1 0). The defendant
may file this form to state objections to the orders the
plaintiff has asked the court to make and to give his or
her side.
actual service in any business for an employer,
whether gratuitously or for wages or pay, and
whether such wages or pay are measured by the
standard of time, piece, task, commission, or other
method of calculation and whether such service is
rendered on a commission, concessionaire, or other 4. Order After Hearing on Petition of Employer for
Injunction Prohibiting Violence or Threats of Violence
Against Employee [Order] (form WV-140). This is the
form signed by the court following the hearing. The
order will stay in effect for up to three years depending
on what the judge rules.
basis. (Lab. Code, § 350(b).)
• Members of boards of directors and public officers. 5. Proof of Personal Service (Workplace Violence) (form
• Volunteers or independent contractors who perform
services for the employer at the employer's work site. WV- 1 30) and Proof of Service of Completed Response
(Workplace Violence) (form WV-1 31). These forms
are used to show that the other party has been served
with the legal documents as required by law.
An employer may seek protection under this law if:
1. An employee has suffered unlawful violence or a
credible threat of violence from any individual; Should you see a
lawyer?
2. The unlawful violence or credible threat of violence
can reasonably be construed to have been carried
out in the workplace;
3. The defendant's conduct is not allowable as part of a You have the right to file a petition or defend against one
and to go to court with or without an attorney. Because
your situation may involve technical problems that cannot
be explained in a printed form, you may want to consult
with an attorney. Whether or not you have an attorney,
the other party may have one.
legitimate labor dispute as permitted by Code of Civil
Procedure section 527.3; and
4. The defendant is not engaged in constitutionally
protected activity.
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INSTRUCTIONS FOR THE PLAINTIFF
What steps need to be taken to get the court
orders? b. You and your applicant's attorney certifies one of
the following to the court under oath:
1. You will need at least five copies of each workplace
violence form: one for a worksheet, the original to file
with the court, a copy to be personally delivered
(served) to the defendant, and two copies for
yourself. In addition, you will need extra copies of the
OSC (form WV-120), the Order (form WV-120), and
the Proof of Service (forms WV-1 30 and WV-1 31).
Get at least three extra copies for yourself. (1) That within a reasonable time prior to the
application you informed the defendant or the
defendant's attorney at what time and where
the application would be made.
(2) That you in good faith attempted but was
unable to inform the defendant and the
defendant's attorney, specifying the efforts
made to contact
them.2. Fill in the Petition (form WV-100), and the OSC
(form WV-120) except for the date(s) for the court
hearing and service, and the judge's signature.
(Reminder: most courts require that all forms be
typewritten.) (3) That for reasons specified you should not be
required to so inform the defendant or the
defendant's attorney.
4. If you are seeking court orders on the basis
of
a. If you are not represented by an attorney, fill in
your name, mailing address, and phone number
at the top of each form.
b. Fill in the name of the county where the case will
be filed and the address of the superior court. information given to you by other persons (e.g., the
affected employee or other employees), and not on the
basis of what you have personally observed, you must
attach to the petition declarations or affidavits by the
persons who have personal knowledge of the facts
that support the granting of the order. You may use
form MC-031 for the declarations.
c. Type your full name, the defendant's full name,
and the employee's full name. If you are seeking
an order protecting more than one employee, you
should fill out a separate set of forms for each
employee to be protected. If you need more
space, attach additional pages and refer to the
additional pages in item 23 of the Petition form. 5. Take all your completed forms and all copies to the
clerk's office in the superior court. The clerk will tell
you where to take your papers.
6. If the judge signs the OSC (form WV-120), take the
d. Check ('X') all boxes that apply to your case.
Read each item carefully and fill in the necessary
information. Be specific.
e. Remember to date and sign the Petition (form
WV-100).
3. If you are applying for a temporary restraining original and all copies back to the court clerk. The clerk
will stamp all the papers with a case number. The
copies will be stamped with an ''En dorsed- Filed'' stamp
(showing the date of filing), the judge's signature, and
the date of signing. The clerk will file the originals and
give you the copies. KEEP AT LEAST THREE
ENDORSED-FILED COPIES FOR YOURSELF. Carry
one with you and give the others to the employee and
other persons, if any, who are to be protected. The
copies may be needed if you have to call the police.
order, you must give the details of the recent acts of
violence or credible threats of violence and the
problems they have caused your employee. Place an
'W' in the box next to "Application for Temporary
Restraining Order.'' 7. Have the defendant personally served with copies of
To obtain a temporary restraining order, you must
notify the defendant of the application for the order
unless both of the following requirements are
satisfied: the Petition (form WV-100) and the OSC (form
WV-120), and blank forms of the Response (form
WV- 11 0) and Proof of Service of Completed Response
(form WV-131). You cannot serve the defendant
yourself. Service may be made by a licensed process
server, the sheriffs department, or any person 1 8
years of age or older, other than you.
a. It appears from facts shown by affidavit,
declaration, or verified complaint that great or
irreparable injury will result before the matter can
be heard on notice. Service is very important. It tells the defendant about
the order and the hearing. Without it there will not be a
court hearing and your temporary orders will no longer
be good unless they are extended by the court. The
defendant must be personally served immediately
after the orders are signed by the judge, unless the
court specifies a different time for service (see item 3a
on the Order to Show Cause).
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8
. If you have requested any temporary orders and the
judge has granted them, immediately deliver copies
of the Temporary Restraining Order (form WV- 1 20)
to each law enforcement agency (police, marshal, or
sheriff's office) that you want to enforce the order.
9
. After the defendant has been personally served, the
person who served the defendant must complete and
sign the original Proof of Personal Service (form
WV-130). You should take the signed original and the
copies back to the court clerk. The clerk will file the
original and stamp ''Endorsed-Filed'' on the copies.
Take one of the Endorsed-Filed copies to each of the
law enforcement agencies where you filed your
Temporary Restraining Order (form WV- 1 20). Keep
three Endorsed-Filed copies for yourself.
10. Go to the court hearing with any evidence you might
have. The Order (form WV-140) should be filled in
and given to the judge for signing. If there are any
witnesses to the defendant's conduct, they should
also be there.
11. If the judge signs the Order (form WV-140), file the
original with the clerk, get the copies stamped with an
" Endorsed- Filed'' stamp, and immediately deliver
copies to law enforcement agencies.
If the defendant was not present in court for the
hearing, arrange to have the defendant personally
served with a copy of the order. File the completed
Proof of Personal Service (form WV- 1 30) with the
court and deliver copies stamped ''Endorsed-Filed'' to
law enforcement agencies. KEEP AT LEAST THREE
COPIES FOR YOURSELF. Give one copy to your
employee, give one to any protected person, carry
one with you, and keep one in a safe place.
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INSTRUCTIONS FOR THE DEFENDANT
1 - If you are served with an Order to Show Cause
(Workplace Violence) [OSC] (form WV-120) and a
Petition of Employer for Injunction Prohibiting
Violence or Threats of Violence Against Employee
[Petition] (form WV-100), you should promptly seek
legal advice. If you have no attorney, the attorney's
reference service of your local bar association may be
of assistance.
2. Read the papers served on you very carefully. The
OSC tells you when to appear in court and may
contain a temporary restraining order forbidding you
from doing certain things. If you disobey the court's
orders, criminal charges may be filed against you.
3. If you wish to oppose the Petition, or make your
own request for court orders, you should file a Response
to Petition of Employer for Injunction Prohibiting
Violence or Threats of Violence Against Employee
[Response] (form WV-110).
In addition to the Response (form WV-110), you may
file and serve declarations signed by persons who
have personal knowledge of the facts. A declaration
(form MC-031) is available from the clerk's office. If
you do not know how to prepare a declaration, you
should see an attorney. After you have filed the
Response with the clerk of the court, a copy must be
delivered personally or by mail to the plaintiff or the
plaintiff's attorney.
You cannot serve the plaintiff yourself. The person
should complete and sign a Proof of Service of
Completed Response (Workplace Violence) (form
WV-131). You should take the completed form back
to the court clerk or bring it with you to the hearing.
4. If you wish to oppose the petition, in addition to filing
a Response, you should be present at the hearing. If
you have any witnesses, they must also be present.
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SUPERIOR COURT OF CALIFORNIA, COUNTY OV- ANY COUNTY S TR E ET AD DR E S S :
1 Court Street
MAILING ADDRESS: P.O. Box 123
A n y t o w n , C a l i f o r n i a 9 1 2 3 4
-
PL AINTIFF: Sarah Jones
DE FENDANT: John Roe
EMPLOYEE: Michael Smith
Corporation
other (specify):
is [2-1 isnot a current employee of plaintiff (explain if defendant is still an employee):
defendant resides in this county.
other (specify):
stalked or [YL:1 made a credible threat of violence againstThe next three pages show a Petition that has been completed, with examples of the kind of information a court
is likely to want.
If you are not represented by an
attorney, fill in your name,
mailing address, and phone
number at the top of each form. The court clerk will give you this
number. Use it on all forms you
file
later. After this form is filed, the clerk
will stamp this box on the copies
so everyone knows it is a copy of
an official paper. This is the place
for the " Endorsed- Filed'' stamp.
County where you are filing your
case. Call the clerk of the court if
you do not know the address of WV-
100
the
court. ATTORNEY OR PARTY WITHOUT ATTORNEY (N--W,-b,~ -I,d~,# FOR COURT USE
ONLY
S a r a h
J o n e s11 0 M a i n S t r e e t
A n y t o w n , C a l i f o r n i a 9 1 2 3 4
Your full
name. TELEPHO
NE 3)555-1234 FAXNCL: (123)55
AT T O R N E Y F O R ( ~ i n p r
The full name of the person you
want the orders against.
The full name of the employee to
be
protected. PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE
OR THREATS OF VIOLENCE AGAINST EMPLOYEE CASE
NUMBER: \
Check this box if you are
asking
for orders to go into effect M Application for Temporary Restraining Order
- (This is NOT an order)
immediately when
the Road the Instructions for Petitions to Prohibit Workplace Violence (fonn KA/-150) before completing this form.
NOTE., Plaintiffmust be an employer with standing to bring this action under Code of Civil Procedure section 527.8.
1. Plaintiff (name): Sarah Jones Is
a sole proprietorship
Temporary Restraining Order is
signed by the judge. You will
also need to check the box at
item 6 and give the necessary
information. and is filing this suit on behalf of the employee identified in Rom 2.
2. Employee (name): Michael
Smith (Use a separate petition for each employee you are seeking
Se x : =
M F Dateofbirth: 12/22/65 to
protect.)
3. Defendant (name): John
Roe i nown): 33 Third Street, #106, Anytown, California
If you are seeking to protect
more than one employee, use a
separate petition. b. works at (state address, ifknown~. Apex Industries, 9420 Commercial Street,
Anytown, California
C
.
Put an 'W' in the box that applies 4. This suit is filed in this county
because
in item 4. You must check one b. M defendant has caused physical or emotional injury to plaintiff's employee in this county.
C
.
bo
x. 5. Defendant has ELI assaulted M
battered the employee by knowing or willing statements or a course of conduct that would place a reasonable person in fear for his or her
safety, or the safety of his or her immediate family.
a. One or more of these acts can reasonably be construed to be carded out or to have bean carried out at the employee's
Item 5 is the most important
part of your petition. This
information is all the judge will
know about your case until the
hearing. Give details of the most
recent incidents. workplace at (address): 110 Main Street
Anytown, California
91234
b. Describe what happened (including the dates, who did what to whom, and any injunes):
I -
- , I own and oper ate a s mall c afe, called Sarah' s Cafe, in Any town. Michael Smith has work ed
for me as a waiter for a long time. About three week s ago J ohn Roe, a c us tomer, got into
an argument with another cus tomer and started shouting. When Mic hael Smith as ked John Roe
to leav e, he refused and pushed Michael against the c ounter. Michael called the polic e.
When they came, J ohn Roe started shouting and threatened to beat Michael up for calling
the polic e. The police took J ohn Roe away, but he came back a week later and Michael
as ked him to leav e. He thr eatened to ' get" Mic hael and his family ( whos e residenc e he
(Cominued on
reverse) f t p -
f , ~
- App~ 1,, 00mW U~
PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING
VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE
(Workplace Violence) C- M ~i l P ~- § 5 V. 8
J,d.dW C-il d CNIf-
WV.100 ~ JW''T 1. ~
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M F Dale of birth:Continued on Attachment 6.
BELOW.
M EU F Date of birth: 1 / 1 7 / 9 5
Continued on An hment 8a.
other (specify):Fill this
in. Leave this
blank.
\
I .
- ,
If you have so many facts that
they will not all fit, put an ''X'' in
this box and write the facts on a
separate piece of paper and
attach it to the back of your
petition, after page three. Use
white paper the same size as
this form. PLAINTIFF (Name): Sarah
Jones
DEFENDANT (Nanta~. John Roe CASE
NUMBER:
5. b. ~CDntinued)
k nows ) and left. Last week, on Marc h 11, at about 11:30 a.m. J ohn Roe c ame in, sat down
at the counter, and demanded that Mic hael ser ve him. Mic hael said he would call the
police if J ohn Roe did not leave, and J ohn Roe pic ked up a ketchup bottle and thr ew it at
Mic hael, hitting him on the arm. John Roe again threatened to "get' Michael and his
family, and then he left. We c alled the police and made a report. I under stand he was
- ~ - 2 ~ a n d s h o r t l y w i ll b e r e le a s e d p e n d in g t r i a l .
Continued on Attachment
5b.
If you are asking for the orders to
go into effect immediately, as
soon as the judge signs the TRO,
you must check this box and
state the reasons. State what
harm would result to the em-
ployee if the orders were not
made immediately. 6. DO Employee will suffer great and irreparable harm before this petition can be heard in court unless the court makes those
orders requested below effective now and until the hearing. (Specify the harm and why it will occurbefore the hearing):
n J o h n R o e i s r e l e a s e d , h e is l ik e l y t o c a r r y o u t h is t h r e a t s a g a in s t M i c h a e l Sm it h
his family. Roe tends to be v iolent. He knows where Smith and his family liv e.
7. Defendant's conduct has been directed against employee and is knowing and willful, is not constitutionally protected, and does not
constitute lawful acts of self-defense or defense of others.
PLAINTIFF REQUESTS THE COURT TO MAKE THE ORDERS INDICATE
a
. RESTRAINING ORDERS M To be ordered now and be effective until the
hearinga. Defendant shall not engage in unlawful violence or make threats of violence against I employesandthe
following members of employee's family or household who reside with the employee:
(1) (Name), Jane
Smith
S
ax
: M M F Date of birth: 3 / 2 7 / 6
6
(2) (Namd): Mary
Smith
S
e
x:(3)
(Name).
Put an ''X'' in the boxes that
apply to your case. S
e
x:
b. Specifically,
defendant
(1) = shall not assault, batter, or stalk the employee and other protected persons
(2) = shall not follow or stalk the employee and other protected persons to or from the place of wor
(3) [2-:1 shall not follow the employee and other protected persons during hours of employment
(4) [T] shall not telephone or send correspondence to the employee and other protected persons by a y means
including, but not limited to, the use of the public or private malls, interoffice mail, tax, or comp r e-mail
Leave the boxes empty if they do
not apply to your case. (5) [10 shall not enter the workplace of the employee and other protected persons
(
6
)
9. M STAY-AWAY ORDERS = To be ordered now and be effective until the hearing
a. Defendant shall stay at least (specify): 100 yards away from the following places an d sses of
the
places are optional and may be kept
confidential):
(2) cz
eyes. Employee's residence (address
optional):
(3)M Employee's place of work (address optional): 110 Main Street
A n y t o w n , C a l i f o r n i
(4) C2:-] Employee's children's school or place of child care (address optionath.
You do not need to give specific
addresses in item 9. However, it
may be easier for the police to
enforce your orders if they know
the defendant knows the
addresses to stay away from. (Continued on page
three)
WV-100 J~w ~.~ 1. 20001
PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING
VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE
(Workplace Violence)
Whenever you check these boxes, you are asking for the
order to go into effect immediately, as soon as the TRO is
signed by the judge. You will also need to check the box at
item 9 and give the necessary information.
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Yes
OTHER ORDERS (specify other orders you reque to help carry out the orders previously requested):
Plaintiff has asked for restraining orders against the defendant in (speafy),
Employee has asked for restraining orders against defendant in (specify):
F Ht.: 6' Wt.: 19 0 Hair color: -Dr- Eye color. _RL_ Race- Wh i te Age:.U- Date of birth: I 0 I I I 5 2List all the agencies you may want to enforce
your order. The court will direct you or your
attorney (if you have one) to deliver the order
personally to the agencies after it is signed.
If you are requesting stay-away
orders, you must check one of
the boxes in item 9b. PLAINTIFF (Name): Sarah
Jones ~E
NUMBER
DEFENDANT (Name): John
Roe
9.
a. (Continur
S (5) Other (specify):
(address
optional):
b. Will granting of any of the stay-away orders in item ga deprive efendant of access to his or her residence or place of
employme
nt?
No (if yes, explain):
This space is where you ask for
other orders you need. If you use
this space, be sure to put in facts
and dates in item 5 on pages
one and two of your Petition that
would give the court a reason to
order what you ask for here. 1
0
. COS
TS
Defendant should be ordered to pay costs as follows (sp city): Cost of service. I will bring
the receipt to the
hearing.
i
f
.
Addre
ss12. Plaintiff requests that copies of orders be given tot following law enforcement agencies:
Law enforcement acen
Any Town Police Department
100 Tuft
StreetAnytown, California 91234
Any Town Police Department Government
HallBig City, California 91345
13. M Plaintiff requests that time for service of the Order to Show Cause (form WV-120) and accompanying papers be shortened
The defendant must be served
---' so that they may be served no less than (specify number): two ( 2 ) days before the date set for the hearing. I need to have
the order shortening time because of the facts contained in this application,
immediately after the orders are
issued, unless the judge short- 1
4
. Count
y,Case No.
(specify):
1
5
. Coun
ty,
ens the time to two days before
the hearing. It is a good idea to
ask for this if you think the
defendant will be hard to find
and serve. Case No.
(specity):
16. DESCRIPTION OF DEFENDANT TO BE RESTRAINED
Sax, r,3n
M
17. Plaintiff requests additional relief as may be proper.
18. ETLI Plaintiff is not required to pay a fee for filing this petition because plaintiff is seeking order(s) restraining violence or threats of
violence (see Code Civ. Proc., § 527(h)). (Note: If the court finds there has been no violence or threats of violence, then you
may be ordered to pay the appropriate
lees-)
19. Plaintiff understands that if the court issues an Order to Show Cause (form WV-120), a hearing will be held on the date shown in
item 2 of the Order to Show Cause. At that hearing, I must be prepared to present evidence supporting the petition.
I declare under penalty of perjury under the laws of the State of California that I am aware of the facts stated,
a. EX:1 on the basis of my own personal knowledge.
b. M on the basis that 1 have been informed and believe that the facts stated are true. (NOTE. If this petition is made soialyon
the basis ofplaintiffs, information and belief, plaintli'must attach declarations orathdavits by one ormore persons who
have personal knowledge of the facts
stated.)
Date: March 10,
2000
Sarah
Jones
. .
. (T~Fi 6N'Pfi]N~
~~E]) (SIGNATURE OF
PI_ktNTIFF)
. . . . . . . . . .
Proprietor, Sarah's Cafe
.
.
.
.
.
.
.
.
.
.(~ OR PRINT NAME) IFA
NY)
t - 1 1 6 0 1 - -
20- Number of gas attached: 3
WY-101)[N"Jamery 1 1
PETITION OF EMPLOYER FOR INJUNCTION Page three of
three
VIOLENCE OR THREATS OF VIOLENCE EMPLOYE
E(Workplace Violence) A G A I N 7
VERY
IMPORTANT
1. The date you sign. 2. Your signature.
DO NOT FORGET THESE OR ALL YOUR WORK WILL BE WASTED
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NAMEOFCOURT. Superior Court of Any County ss, 1 Court
Street
- -' Zu -A DO RE ss . P.O. Box 123
cn-YANozipcooe Anytown, California 91234
BRANCH NAME
PLAINTIFF: Sarah Jones
DEFENDANT: John Roe
EMPLOYEE: Michael Smith
is (Spectw,
SIGNATURE FOLLOWS LAST ATTACHMENTTHIS FORM IS CALLED THE ORDER TO SHOW CAUSE AND TEMPORARY RESTRAINING ORDER (''OSC/TRO'' OR
''TRO''). THIS IS THE ORDER YOU WANT THE JUDGE TO SIGN. AFTER THE JUDGE SIGNS THE ORDER, YOU CAN
HAVE THE ORDER ENFORCED BY LAW ENFORCEMENT AGENCIES.
Note: Fill in the OSC in
the
same way as your
Petition
except as follows: The clerk will give you this
number after the judge signs the
TRO. Use it on all the forms you
1. Leave items 2a and 3a-d
on the OSC blank. The
clerk of the court or the
judge will insert the date.
Your hearing will be within
15 days after the filing of
the Petition. file
later. After this form is filed, the clerk will
stamp this box on the copies so
everyone knows it is a copy of an
official paper.
WV-
120
ATTORNEY OR P~ WRIHOUT ArrOANCY (~,---ft ~~ ,,d,
Sarah Jones F
O
R U SE
M y
2. Do not date or sign
the 110 Main
Street
0sc
. Anytown, California 91234
TELEPHONE NO, ( 1 2 3 ) 5 5 5 - 1 2 3 4 FAX
NO, ( 1
ATTORNEY FOR JAWW~ in pro per
County where you are filing your
case. Call the clerk of the court if
you do not know the address. -
CASE
NUMBER:
ORDER TO SHOW CAUSE (Workplace Violence)
and Temporary Restraining Order (CLETS)
LEAVE THIS BLANK. The clerk,
or the judge, will put the date in. THIS ORDER SHALL EXPIRE AT THE DATE AND THE TIME OF THE HEARING SHOWN IN THE BOX BELOW UNLESS
EXTENDED BY THE COURT.
1. To Defendant (name): John Roe
NOTICE OF
HEARINGto appear in this court at the date, time, and place shown in the box below to give any legal reason why the
other relief requested in the petition should not be granted.
a.
Date: Ti
me
: De
pt.: Roo
m:
b. The address of the court where the hearing will beheld
is shown
above
The orders that follow are good
only until the hearing. At the
hearing, the court can make the
orders last for as long as three
years. 3. IT IS FURTHER ORDERED that
a. Plaintiff shall serve this Order to Show Cause, the attached Petition (form WV-100), and any other supporting papers by (specify
mannerofservim)
no later than
(date):
b. Any opposition papers shall be filed and served on plaintiff by (specify manner ofservice):
no later than
(date):
c. Any reply papers shall be filed and served by (specify manner ofservica):
no later than
(date):
d. Proof of service of plaintiff's papers shall be delivered to the court hearing the Order to Show Cause
no later than
(date):
4. You have the right to attend the hearing to oppose the petition, with or without an attorney. If you do not attend the hearing, the court
may grant the requested orders without any further notice to you. The court may make these orders enforceable for a period not to
exceed three years, after which they may be renewed, by filing a new Petition for Injunction. You should read the instructions on
page two of this form. A complete instruction booklet (form VIV-1 50) is available from the clerk's office located at the court shown
above.
Da
te:
JUDGE OF THE SUPERIOR
COURT
(Continued on
reverse) ng. - .1
loor
Fonn Apion-I W Optional Use
ORDER TO SHOW CAUSE AND
TEMPORARY RESTRAINING ORDER (CLETS)
(Workplace Violence) Gods of CMI P,.atloni, J 627.0
Ju~lai council of
Calikorni. penal Co0a, J
273.8(a)
WV-120 [Na, Anoary 1, 20001
OVV-1 50 [New January 1, 20001
Page
nineelectronic form ã 1999
WWW.LawCA.co
m
Law Publishers
M F Date of birth: –––––
F Ht.: 6 ' Wt 190 Haircolor. Br. Eyemlor.Br. Race:White Age: 48 Dateofbirth: 10/1/52
M F Date of birth: 3/27/66
M = F D a t e o f b i r t h : 1 / 1 7 / 9 5
Continued on Attachment 5c.
other (specify):PLAINTIFF (Name): Sarah
Jones
DEFENDANT (Name): John Roe CASE
NUMBER
TEMPORARY RESTRAINING ORDER
Fill in the defendant's name and
other information to help the law
enforcement officer locate and
identify him or her. Violation of this order Is a misdemeanor, punishable by a $1,000 fine, one year In jail, or both, or may be punishable as
a felony. This order shall be enforced by all law enforcement officers In the State of California. Any person subject to a
restraining order Is prohibited from obtaining or purchasing or attempting to obtain or purchase a firearm by Penal
Code section 12021. Such conduct may be a felony and punishable by a $1,WO fine and Imprisonment.
THE COURT
FINDS
5. a. The defendant is (name): John Roe
S -
m
b. The protected employee Is (name): Mi chael Smith
c. Protected family or household members who reside with employee are:
0)(Namls~ Jane Smith
Sa
x
:(2)(Nama~ Mary Smith
S
e
x:
(3)
(Narnffi
S
a
x;
Put an 'X' in the boxes that
apply to your case; leave boxes
empty if they do not apply to your
case. UNTIL THE TIME OF HEARING, IT IS
ORDERED
6. Defendant is prohibited from further violence or threats of violence against protected parson.
and SPECIFICALLY IT IS ORDERED THAT DEFENDANT
a. shall not assault. batter, or stalk the employee and other protected persons
b. shall not follow or stalk the employee and other protected persons to or from the place of work
C. shall not follow the employee and other protected persons during hours of employment
d. shall not telephone or send correspondence to the employee and other protected persons by any means Including, but not
a
. X limited to, the use of the public or private mails, interoffice mail, fax, or computer e-mail
shall not enter the workplace of the employee and other protected persons
1
.
You do not need to give specific
addresses in item 7. However, it
may be easier for the police to
enforce your orders if they know
the defendant knows the
addresses to stay away from. 7
. Defendant is ordered to stay at least
(specify)~ 1
0
0 yards away from the following persons and
places
(the addresses of the places are optional and may be kept
confidential):
a
. x
Employes and other protected persons (names): Michael Smith, Jane Smith, Mary Smith
b
. Residence of employee and other protected persons (address optional): 110 Main Street
Anytown,
CaliforniaC
. Place of work of employee and other protected persons (address optional):
(Continved on
reverse)
WV-120 [N~Jwuwy 1,
MW] ORDER TO SHOW CAUSE AND
TEMPORARY RESTRAINING ORDER (CLETS)
(Workplace Violence) Palp thm 0 1~
WV-150 [New January 1, 2000]
Paget
enelectronic form ã 1999
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m
Law Publishers
Other (specify):
Contacts relating to pickup and delivery of children pursuant to a court order or a court approved stipulation of the parties
OTHER ORDERS (specify):
plaintiff's attorney shall deliver.
SIGNATURE FOLLOWS LAST ATTACHMENTPLAINTIFF (Name): Sarah
Jones
DEFENDANT (Name): John Roe CAkSE
NUMBER
7.
(Continued)
d. School or place of child care of children of employee and other protected persons (address optionaJ~.
Item 10 lists the papers that
must be personally served on
the defendant. 8
.
(address
optional):
8
.
arrived at during mediation shall be permitted, unless a criminal domestic protective or restraining order prohibits such
contac
ts.
9
.
Some courts may require that
the defendant be served at least
15 days before the hearing. But
the court can shorten the time.
no less than (specify number~. two ( 2 )
a. Order to Show Cause and Temporaty Restraining Order (CLETS) (Woniplace Violence) (form WV-120)1 0. Application for an order shortening time is granted and the following documents shall be personally served on the defendant
days before the time set for hearing:
b. Petition of Employer for Injunction Against Violence or Threats of Violence Against Employee (Woriplace Violence)
(WV-
100)
c. blank Response to Petition of Employer for Injunction Prohibiting Violence or Threats of Violence Against Employee
(Workplace Violence) (WV-1 1
0)
d. blank Proof of Service of Completed Response (form WV-1 31)
a. other (specify):
List the addresses of all law
enforcement agencies that
11. Bylhe close of business on the date of this order, a copy of this order and any proof of service shall be given to the
law
enforce the law
whereharassment has occurred or is
likely to occur in the future. enforcement agencies listed below as follows
a- [-M plaintiff shall deliver.
b
.
Law enforcement acencv
Addre
ss
Any Town Police Department 100 Tuft
StreetAnytown, California 91234
Any Town Police Department Government
HallBig City, California 91345
THIS ORDER IS EFFECTIVE WHEN MADE. THE LAW ENFORCEMENT AGENCY SHALL ENFORCE THE ORDER
IMMEDIATELY UPON RECOPY. IT IS ENFORCEABLE ANYWHERE IN CALIFORNIA BY ANY LAW ENFORCEMENT
AGENCY THAT HAS RECEIVED THE ORDER OR IS SHOWN A COPY OF THE ORDER. IF PROOF OF SERVICE ON THE
RESTRAINED PERSON HAS NOT BEEN RECEIVED THE LAW ENFORCEMENT AGENCY SHALL ADVISE THE
RESTRAINED PERSON OF THE TERMS OF THE OiDER AND THEN SHALL ENFORCE IT.
After it is signed by the
judge, you or
your attorney must take
acopy of this order to
the Da
te: JUDGE OF THE SUPERK)R
COURT
law
enforcementagencies immediately if
you want them to be
able M . 1 X I N - J ~ 1 , ~ 1
ORDER TO SHOW CAUSE AND
TEMPORARY RESTRAINING ORDER (CLETS)
(Wodq)lace Violence) P ~ W , d
I -
to enforce
it.
WV-1 50 [New January 1, 2000]
Page
elevenelectronic form ã 1999
WWW.LawCA.co
m
Law Publishers
