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It collects key identity and hiring-employer details, wage and overtime rate information, written-agreement status, and regular payday details. It also captures workers’ compensation coverage, paid sick leave entitlements and applicable accrual exemptions, plus emergency or disaster disclosure when a recent declaration may affect health and safety. An acknowledgement of receipt section records signatures and dates.","| NOTICE TO EMPLOYEE\u003Cbr>Labor Code section 2810.5 |\n| --- |\n| EMPLOYEE |\n| Employee Name:  \u003Cbr>Start Date:   |\n| EMPLOYER |\n| Legal Name of Hiring Employer:   Is hiring employer a staffing agency/business (e.g., Temporary Services Agency; Employee Leasing Company; or\u003Cbr>Professional Employer Organization [PEO])? □ Yes □ No\u003Cbr>Other Names Hiring Employer is \"doing business as\" (if applicable):\u003Cbr>Physical Address of Hiring Employer’s Main Office:\u003Cbr>Hiring Employer’s Mailing Address (if different than above):\u003Cbr>Hiring Employer’s Telephone Number:  \u003Cbr>If the hiring employer is a staffing agency/business (above box checked \"Yes\"), the following is the other entity for whom this employee will perform work:\u003Cbr>Name:   Physical Address of Main Office:   Mailing Address:   Telephone Number:   |\n| WAGE INFORMATION |\n| Rate(s) of Pay:   Overtime Rate(s) of Pay:   Rate by (check box): □ Hour □ Shift □ Day □ Week □ Salary □ Piece rate □ Commission\u003Cbr>□ Other (provide specifics):  \u003Cbr>Does a written agreement exist providing the rate(s) of pay? (check box) □ Yes □ No\u003Cbr>If yes, are all rate(s) of pay and bases thereof contained in that written agreement? □ Yes □ No\u003Cbr>Allowances, if any, claimed as part of minimum wage (including meal or lodging allowances):\u003Cbr>(If the employee has signed the acknowledgment of receipt below, it does not constitute a “voluntary written agreement” as required under the law between the employer and employee in order to credit any meals or lodging against the minimum wage. Any such voluntary written agreement must be evidenced by a separate document.)\u003Cbr>Regular Payday:   |\n\n\n| WORKERS’ COMPENSATION |\n| --- |\n| Insurance Carrier’s Name:   Address:   Telephone Number:   Policy No.:  \u003Cbr>□ Self-Insured (Labor Code 3700) and Certificate Number for Consent to Self-Insure:   |\n| PAID SICK LEAVE |\n| Unless exempt, the employee identified on this notice is entitled to minimum requirements for paid sick leave under state law which provides that an employee:\u003Cbr>a. May accrue paid sick leave and may request and use up to 5 days or 40 hours, whichever is greater, of accrued paid sick leave per year;\u003Cbr>b. May not be terminated or retaliated against for using or requesting the use of paid sick leave; and\u003Cbr>c. Has the right to file a complaint against an employer who retaliates or discriminates against an employee for\u003Cbr>1. requesting or using sick days;\u003Cbr>2. attempting to exercise the right to use paid sick days;\u003Cbr>3. filing a complaint or alleging a violation of Article 1.5 section 245 et seq. of the California Labor Code;\u003Cbr>4. cooperating in an investigation or prosecution of an alleged violation of this Article or opposing any policy or practice or act that is prohibited by Article 1.5 section 245 et seq. of the California Labor\u003Cbr>The following applies to the employee identified on this notice: (Check one box)\u003Cbr>□ 1. Accrues paid sick leave only pursuant to the minimum requirements stated in Labor Code §245 et seq. with no other employer policy providing additional or different terms for accrual and use of paid sick leave.\u003Cbr>□ 2. Accrues paid sick leave pursuant to the employer’s policy which satisfies or exceeds the accrual, carryover, and use requirements of Labor Code §246 .\u003Cbr>□ 3. Employer provides no less than 40 hours (or 5 days) of paid sick leave at the beginning of each 12-month period.\u003Cbr>□ 4. The employee is exempt or partially exempt from paid sick leave by Labor Code §245.5 . (State exemption and subsection for exemption): |\n| EMERGENCY OR DISASTER DISCLOSURE |\n| □ There is a state or federal emergency or disaster declaration applicable to the county or counties where the employee will work issued within 30 days before the employee’s first day of employment and that may affect their health and safety during employment. (State emergency or disaster declaration and how it may affect health or safety)\u003Cbr>______________________________________________________________________________________________\u003C","cbCaihuh7wC4O9ct","https://ap.wps.com/l/cbCaihuh7wC4O9ct","pdf",134514,2,"English","en",105,"# NOTICE TO EMPLOYEE\n## Labor Code section 2810.5\n## Employee and Employer Information\n## Wage Information\n## Workers’ Compensation\n## Paid Sick Leave\n## Emergency or Disaster Disclosure\n## Acknowledgement of Receipt","[{\"question\":\"What information must be provided for the employee and hiring employer?\",\"answer\":\"The form requests the employee name and start date, and the hiring employer’s legal name, staffing/PEO status, other “doing business as” names, and address and telephone details. If staffing is involved, it also collects information about the other entity for whom the employee will perform work.\"},{\"question\":\"What wage and overtime fields are included in the notice?\",\"answer\":\"It requires rate(s) of pay and overtime rate(s), including the pay rate basis selection (hour, shift, day, week, salary, piece rate, commission, or other). It also asks whether a written agreement exists and whether all pay rates and bases are contained within it, and it includes regular payday.\"},{\"question\":\"How does the notice address paid sick leave and when are exemptions applied?\",\"answer\":\"It states minimum paid sick leave entitlements, including accrual and protections against termination or retaliation. It then provides options for how the employee accrues paid sick leave—minimum requirements only, an employer policy meeting or exceeding requirements, at least 40 hours/5 days at each 12-month period start, or being exempt/partially exempt under the specified Labor Code section.\"}]","Notice to Employee - Labor Code section 2810.5 | PDF",1788382466,{"code":4,"msg":30,"data":31},"ok",{"site_id":24,"language":23,"slug":32,"title":14,"keywords":33,"description":15,"schema_data":34,"social_meta":85,"head_meta":87,"extra_data":89,"updated_unix":28},"notice-to-employee-labor-code-section-28105","",{"@graph":35,"@context":84},[36,52,67],{"@type":37,"itemListElement":38},"BreadcrumbList",[39,43,46,49],{"item":40,"name":41,"@type":42,"position":11},"https://docshare.wps.com","Home","ListItem",{"item":44,"name":45,"@type":42,"position":21},"https://docshare.wps.com/template/","Template",{"item":47,"name":13,"@type":42,"position":48},"https://docshare.wps.com/template/letters/",3,{"item":50,"name":14,"@type":42,"position":51},"https://docshare.wps.com/template/notice-to-employee-labor-code-section-28105/187349/",4,{"url":50,"name":14,"@type":53,"author":54,"headline":14,"publisher":56,"fileFormat":59,"inLanguage":23,"description":15,"dateModified":60,"datePublished":61,"encodingFormat":59,"isAccessibleForFree":62,"interactionStatistic":63},"DigitalDocument",{"name":9,"@type":55},"Person",{"url":40,"name":57,"@type":58},"DocShare","Organization","application/pdf","2026-09-05","2026-09-02",true,{"@type":64,"interactionType":65,"userInteractionCount":48},"InteractionCounter",{"@type":66},"ViewAction",{"@type":68,"mainEntity":69},"FAQPage",[70,76,80],{"name":71,"@type":72,"acceptedAnswer":73},"What information must be provided for the employee and hiring employer?","Question",{"text":74,"@type":75},"The form requests the employee name and start date, and the hiring employer’s legal name, staffing/PEO status, other “doing business as” names, and address and telephone details. If staffing is involved, it also collects information about the other entity for whom the employee will perform work.","Answer",{"name":77,"@type":72,"acceptedAnswer":78},"What wage and overtime fields are included in the notice?",{"text":79,"@type":75},"It requires rate(s) of pay and overtime rate(s), including the pay rate basis selection (hour, shift, day, week, salary, piece rate, commission, or other). It also asks whether a written agreement exists and whether all pay rates and bases are contained within it, and it includes regular payday.",{"name":81,"@type":72,"acceptedAnswer":82},"How does the notice address paid sick leave and when are exemptions applied?",{"text":83,"@type":75},"It states minimum paid sick leave entitlements, including accrual and protections against termination or retaliation. 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