WV-150-INFO 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 Civil Harassment (form CH-150). Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least 5 days before the hearing. Contact the clerk's office for Request for Accommodations by Persons With Disabilities and Order (form MC-410). (Civil Code, § 54.8.) Form Adopted for Mandatory Use Judicial Council of California WV-150-INFO [Rev. January 1, 2007] Page 1 of 12 American LegalNet, Inc. www.FormsWorkflow.com GENERAL INFORMATION WV-150-INFO 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 against 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 court clerk's office or legal publishers. The clerk of the court can tell you where to get the forms. You can also obtain them on the California Courts Web site (www.courtinfo.ca.gov/forms). Fillable forms are available on the Web site. • 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).) • A federal, state, or local public agency; a city, county, district, or public corporation. (Code Civ. Proc., § 527.8(d).) 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? Under this statute, employers can obtain court orders which last up to 3 years on behalf of their employees only and up to 15 days on behalf of employees and certain family or household members. California law defines employees as: • Every person, including aliens and minors, rendering 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 basis. (Lab. Code, § 350(b).) • Members of boards of directors and public officers. • Volunteers or independent contractors who perform services for the employer at the employer's work site. 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; 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 legitimate labor dispute as permitted by Code of Civil Procedure section 527.3; and 4. The defendant is not engaged in constitutionally protected activity. WV-150-INFO [Rev. January 1, 2007] 2. Someone other than yourself, 18 years of age or older, to deliver (serve) certain papers to the other party. What forms must be used 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 [Petition] (form WV-100). This four-page form tells the judge the facts of the plaintiff's case and what orders the plaintiff wants the court to make. This form is mandatory, i.e., it must be used to petition for injunctive relief. 2. Order to Show Cause [OSC] and Temporary Restraining Order [TRO] (form WV-120). The OSC, when signed by the judge, tells the defendant to come to court for the hearing. It may include one or more TROs that take effect immediately and stay in effect until the hearing. 3. Response to Petition of Employer for Injunction Prohibiting Violence or Threats of Violence Against Employee [Response] (form WV-110). The defendant files this form to state objections to the orders the plaintiff has asked the court to make and to give his or her side. This form is mandatory, i.e., it must be used by defendants to respond to a petition. 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. 5. Proof of Personal Service (form WV-130) and Proof of Service By Mail of Completed Response (form WV-131). These forms are used to show that the other party has been served with the legal documents as required by law. Should you see a lawyer? You have the right to file a petition or defend against one and to go to court with or without an attorney, unless you are a corporation in which case you must be represented by a lawyer. 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. Page 2 of 12 WV-150-INFO INSTRUCTIONS FOR THE PLAINTIFF What steps need to be taken to get the court orders? 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-130 and WV-131). Get at least three extra copies for yourself. 2. Fill in the Petition (form WV-100), and fill in the OSC (form WV-120) except for the dates for the court hearing and service and the judge's signature. a. If you are not represented by an attorney, fill in your name, mailing address, and phone number at the top of each form. You may, but are not required to, provide a fax number and an e-mail address where you may be contacted. b. Fill in the name of the county where the case will be filed and the address of the superior court. 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 19 of the Petition form. 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. 3. If you are applying for a TRO, 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 "X" in the caption of the Petition next to "Application for Temporary Restraining Order." To obtain a TRO, you must notify the defendant of the application for the order unless both of the following requirements are satisfied: 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. WV-150-INFO [Rev. January 1, 2007] b. You or your attorney certifies one of the following to the court under oath: (1) That within a reasonable time prior to the petition you informed the defendant or the defendant's attorney at what time and where the petition would be made. (2) That you in good faith attempted but were unable to inform the defendant and the defendant's attorney, specifying the efforts made to contact them. (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 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. 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 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 "Endorsed-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. Ask for at least three endorsed-filed copies. Keep at least one for yourself 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. 7. Have the defendant personally served with copies of the Petition (form WV-100) and the OSC (form WV-120), a blank Response (form WV-110), and a blank Proof of Service By Mail of Completed Response (form WV-131). You cannot serve the defendant yourself. Service may be made by a licensed process server, the sheriff's department, or any person 18 years of age or older, other than you. 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 4a on the OSC). Page 3 of 12 WV-150-INFO 8. 9. If you have requested any temporary orders and the judge has granted them, get copies of the TRO stamped with an ''Endorsed-Filed'' stamp and immediately deliver an Endorsed-Filed copy of the TRO to each law enforcement agency (police, marshal, or sheriff's office) that you want to enforce the order. 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 TRO. 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 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-130) with the court. Keep at least three copies for yourself. Give one copy to your employee, give one to any other protected person, and keep at least one for yourself. 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 referral 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 must file a Response to Petition of Employer for Injunction Prohibiting Violence or Threats of Violence Against Employee [Response] (form WV-110). These forms are available at the court clerk's office or at the California Courts Web site: www.courtinfo.ca.gov/forms. WV-150-INFO [Rev. January 1, 2007] 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 or on the California Courts Web site. 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 who does serve your papers should complete and sign a Proof of Service By Mail of Completed Response (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. Page 4 of 12 WV-150-INFO The 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. 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. The court clerk will give you this number. Use it on all forms you file later. The county where you are filing your case. Call the clerk of the court if you do not know the address of the court. WV-100 FOR COURT USE ONLY Sarah Jones 110 Main Street Anytown, California 91234 FAX NO. (Optional): ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): Your full name. The full name of the person you want the orders against. TELEPHONE NO: (123) 555-1234 E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: P.O. Box 123 CITY AND ZIP CODE: BRANCH NAME: Anytown, California 91234 PLAINTIFF: The full name of the employee to be protected. Check this box if you are asking for orders to go into effect immediately when the TRO is signed by the judge. You will also need to check the box at item 7 and give the necessary information. DEFENDANT: EMPLOYEE: Sarah Jones John Roe Michael Smith PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) AND x APPLICATION FOR TEMPORARY RESTRAINING ORDER 1. Plaintiff (name): is a other (specify): corporation x sole proprietorship and is filing this suit on behalf of the employee identified in item 2. 2. Employee (name): x M F Date of birth: __________________ 12/22/65 (Use a separate petition for each employee you are seeking to protect.) 3. Defendant (name): Sex: M F Ht.: Wt.: Hair color: Eye color: a. Resides at (address, if known): Race: Age: Date of birth: 33 Third Street, #106, Anytown, California 94124 b. Works at (address, if known): Insert the employee's name in item 2. CASE NUMBER: Read the Instructions for Petitions to Prohibit Workplace Violence (form WV-150) before completing this form. NOTE: Plaintiff must be an employer with standing to bring this action under Code of Civil Procedure section 527.8. Sex: Insert your name and check the box for the type of business in item 1. ANY COUNTY 1 Court Street Apex Industries, 9420 Commercial Street, Anytown, California 94125 c. Is x Is not a current employee of plaintiff (explain if defendant is still an employee): 4. This suit is filed in this county because Provide a description of the defendant to be restrained in item 3. If you are seeking to protect more than one employee, use a separate Petition for each employee. Put an "X" in the box that applies in item 4. You must check one box. WV-150-INFO [Rev. January 1, h2007] a. b. c. defendant resides in this county. x defendant has caused physical or emotional injury to plaintiff's employee in this county. other (specify): made a credible threat of violence against 5. Related Actions a. Plaintiff has asked, or is asking, for restraining orders against the defendant in (specify): case no. (specify): County, b. Employee has asked, or is asking, for restraining orders against the defendant in (specify): case no. (specify): County, c. Other related actions (describe): (This is not a Court Order.) Form Adopted for Mandatory Use Judicial Council of California WV-100 [Rev. January 1, 2007] PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) Page 1 of 4 Code of Civil Procedure, §§ 527.8 and 527.9 Page 5 of 12 WV-150-INFO Fill this in. Item 6b 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. Leave this blank. CASE NUMBER: PLAINTIFF (Name): Sarah Jones DEFENDANT (Name): John Roe x made a credible threat of violence against stalked or x assaulted x battered 6. Defendant has 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. If you have so many facts that they will not all fit, put an "X" in this box, write the facts on a separate piece of paper, and attach it to the end of your Petition. Use white paper the same size as this form. a. One or more of these acts can reasonably be construed to be carried out or to have been carried out at the employee's workplace at (address): 110 Main Street Anytown, California 91234 b. Describe what happened (including the dates, who did what to whom, and any injuries): I own and operate a small cafe, called Sarah's Cafe, in Anytown, Michael Smith has worked for me as a waiter for a long time. About three weeks ago John Doe, a customer, got into an argument with another customer and started shouting. When Michael Smith asked John Doe to leave, he refused and pushed Michael against the counter. Michael called the police. When they came, John Roe started shouting and threatened to beat Michael up for calling the police. the police took John Roe away, but he came back a week later and Michael asked him to leave. He threatened to "get" Michael and his family (whose residence he knows) and left. Last week, on March 11, at about 11:30 a.m., John Roe came in, sat down at the counter, and demanded that Michael serve him. Michael said he would call the police of John Roe did not leave, and John Roe picked up a ketchup bottle and threw it at Michael, hitting him on the arm. John Roe again threatened to "get" Michael and his family, and then he left. We called the police and made a report. I understand he was arrested and shortly will be released pending trial. Continued on Attachment 6b. 7. 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 employee if the orders were not made immediately. x 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 occur before the hearing): When John Roe is released, he is likely to carry out his threats against Michael Smith and his family. Roe tends to be violent. He knows where Smith and his family live. Continued on Attachment 7. 8. 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 INDICATED BY THE CHECK MARKS IN THE BOXES BELOW. 9. x PERSONAL CONDUCT ORDERS M F Date of birth: 3/27/66 M Sex: x F Date of birth: 1/17/95 (3) (Name): M F Date of birth: Continued on Attachment 9a. b. Specifically, defendant (4) x x x x (5) Put an "X" in the boxes that apply to your case. Leave the boxes empty if they do not apply to your case. x (2) (Name): Mary Smith Sex: Identify the members of the employee's family or household to be protected in item 9a. To be ordered now and effective until the hearing (1) (Name): Jane Smith Sex: Indicate the orders that you are requesting by checking the appropriate boxes in item 9. x a. Defendant shall not engage in unlawful violence or make threats of violence against the employee and the following members of employee's family or household who reside with the employee: x (1) (2) (3) (6) shall not assault, batter, or stalk the employee and other protected persons. shall not follow or stalk the employee and other protected persons to or from the place of work. shall not follow the employee and other protected persons during hours of employment. shall not telephone or send correspondence to the employee and other protected persons by any means including, but not 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. other (specify): The court shall order that the defendant is prohibited from taking any action to obtain the address or location of the employee or any of the employee's family members or caretakers unless the court finds that good cause not to make that order. (This is not a Court Order.) WV-100 [Rev. January 1, 2007] PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) Page 2 of 4 Whenever you check this box, 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 6 and give the necessary information. WV-150-INFO [Rev. January 1, 2007] Page 6 of 12 WV-150-INFO Fill this in. Leave this blank. CASE NUMBER: PLAINTIFF (Name): Sarah Jones DEFENDANT (Name): John Roe 10. x x To be ordered now and effective until the hearing STAY-AWAY ORDERS a. Defendant shall stay at least (specify):_150__ yards away from the following places and persons (the addresses of the places are optional and may be kept confidential): (1) Employee (2) x x and other protected person identified in item 9a. Employee's residence (address optional): (3) x Employee's place of work (address optional): 110 Main Street Anytown, California 91234 (4) x Employee's children's school or place of child care (address optional): (5) You do not need to give specific addresses in item 10. However, it may be easier for the police to enforce your orders if they know the defendant knows the addresses to stay away from. x (6) Employee's vehicle (specify): 1995 White Toyota Sedan (Lic. No.: 9XYZ123) Other (specify): b. Will granting of any of the stay-away orders in item 9a deprive defendant of access to his or her residence or place of employment? Yes If you are requesting stay-away orders, you must check one of the boxes in item10b. No (If yes, explain): 11. FIREARMS PROHIBITION AND RELINQUISHMENT ORDER Plaintiff requests an order under section 527.9 of the Code of Civil Procedure that the restrained person is prohibited from owning, possessing, purchasing, or receiving, or attempting to purchase or receive a firearm, and must relinquish any firearm that he or she owns or possesses. 12. This space is where you ask for other orders you need. If you use this space, be sure to put in item 6b of your Petition facts and dates that give the court a reason to order what you ask for here. x 13. OTHER ORDERS (specify other orders you request to help carry out the orders previously requested): DELIVERY TO LAW ENFORCEMENT Plaintiff requests that copies of orders be given to the following law enforcement agencies: Law enforcement agency Address Anytown Police Department 100 Tuft Street Anytown, California 91234 Anytown Police Department 14. Government Hall Big City, California 91235 TIME FOR SERVICE Plaintiff requests that time for service of the Order to Show Cause and Temporary Restraining Order (form WV-120) and accompanying papers be no less than (check one): 5 days (specify number): days before the date set for the hearing. (If you need an order shortening the time to fewer than 5 days, explain the reasons.) (This is not a Court Order.) WV-100 [Rev. January 1, 2007] PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) The defendant must be served immediately after the orders are issued, unless the judge shortens 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. WV-150-INFO [Rev. January 1, 2007] Page 3 of 4 List 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. Page 7 of 12 WV-150-INFO CASE NUMBER: PLAINTIFF (Name): DEFENDANT (Name): 15. Check the box if your Petition contains the allegations stated in item 17. COSTS Defendant should be ordered to pay costs as follows (specify): 16. Plaintiff requests additional relief as may be proper. 17. x NO FEE FOR FILING Plaintiff is not required to pay a fee for filing this petition because the petition alleges that the defendant has inflicted or threatened violence against an employee of the plaintiff, or stalked the employee, or acted or spoke in any other manner that has placed the employee in reasonable fear of violence, and plaintiff seeks protective or restraining orders or injunctions restraining stalking or future violence or threats of violence in an action brought under Code of Civil Procedure section 527.8. 18. 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, plaintiff will be prepared to present evidence supporting the petition. 19. Number of pages attached: _0__ (TYPE OR PRINT NAME OF ATTORNEY) (SIGNATURE OF ATTORNEY) I declare under penalty of perjury under the laws of the State of California that I am aware of the facts stated, a. b. x x on the basis of my own personal knowledge. on the basis that I have been informed and believe that the facts stated are true. (NOTE: If this petition is made solely on the basis of plaintiff's information and belief, plaintiff must attach declarations by one or more persons who have personal knowledge of the facts stated.) Date: March 18, 2005 Sarah Jones Sarah Jones (TYPE OR PRINT NAME) (SIGNATURE OF PLAINTIFF) Title of person signing: Proprietor, Sarah's Cafe (This is not a Court Order) WV-100 [Rev. January 1, 2007] PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) Page 4 of 4 VERY IMPORTANT 1. The date you sign. 2. Your signature. DO NOT FORGET THESE OR ALL YOUR WORK WILL BE WASTED. WV-150-INFO [Rev. January 1, 2007] Page 8 of 12 WV-150-INFO THIS 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: 1. Leave items 2a–b and 4a–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. The clerk will give you this number after the judge signs the TRO. Use it on all the forms you file later. After this form is filed, the clerk will stamp this box on each copy so everyone knows it is a copy of an official paper. This is the place for the "Endorsed-Filed" stamp. WV-120 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): Sarah Jones 110 Main Street Anytown, California 91234 TELEPHONE NO.: (123) 555-1234 E-MAIL ADDRESS (Optional): sjoney@e-mail.com ATTORNEY FOR (Name): in pro per FOR COURT USE ONLY FAX NO. (Optional): (123) 555-1235 SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: 1 Court Street 2. Do not date or sign the OSC. MAILING ADDRESS: P.O. Box 123 CITY AND ZIP CODE: Anytime, California 91234 BRANCH NAME: The county where you are filing your case. Call the clerk of the court if you do not know the court's address. PLAINTIFF: Sarah Jones DEFENDANT: John Roe EMPLOYEE: Michael Smith CASE NUMBER: ORDER TO SHOW CAUSE (Workplace Violence) x AND TEMPORARY RESTRAINING ORDER (CLETS) 1. Leave this blank. The clerk or the judge will put the information in or tell you what information to insert here. 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 2. YOU ARE ORDERED to appear in this court at the date, time, and place shown in the box below to give any legal reason why the order sought and the other relief requested in the petition should not be granted. NOTICE OF HEARING a. Date: b. The address of the court where the hearing will be held 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. Room: Dept.: Time: x is shown above is (specify): 3. 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 WV-150) is available from the clerk’s office located at the court shown above. 4. IT IS FURTHER ORDERED that a. Plaintiff shall serve this Order to Show Cause, the attached Petition of Employer for injunction Prohibiting Violence or Threats of Violence Against Employee (Workplace Violence) (form WV-100), and any other supporting papers by (specify manner of service): no later than (date): b. Any opposition papers shall be filed and served on plaintiff by (specify manner of service): no later than (date): c. Any reply papers shall be filed and served by (specify manner of service): 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): Date: JUDICIAL OFFICER SIGNATURE FOLLOWS LAST ATTACHMENT Page 1 of 4 Form Approved for Optional Use Judicial Council of California WV-120 [Rev. January 1, 2007] WV-150-INFO [Rev. January 1, 2007] ORDER TO SHOW CAUSE AND TEMPORARY RESTRAINING ORDER (CLETS) (Workplace Violence) Code of Civil Procedure,§§ 527.8 and 527.9; Penal Code, § 273.6(a) Page 9 of 12 WV-150-INFO Fill this in. Leave this blank. CASE NUMBER: PLAINTIFF (Name): Sarah Jones DEFENDANT (Name): John Roe Fill in the defendant's name and other information to help the law enforcement officer locate and identify him or her. TEMPORARY RESTRAINING ORDER THE COURT FINDS 5 a. The defendant is (name): Sex: x M F Ht.:____ Wt.:____ Hair color: _____ Eye color: Race: Age: Date of birth: b. The protected employee is (name): Sex: M x F Date of birth: 1/17/95 c. Protected family or household members who reside with employee are: (1) (Name): M x F Date of birth: M x F Date of birth: 3/27/66 M Sex: x F Date of birth: 1/17/95 (2) (Name): Put an "X" in the boxes that apply to your case. Leave boxes empty if they do not apply to your case. Sex: (3) (Name): Sex: Continued on Attachment 5c. UNTIL THE TIME OF HEARING, IT IS ORDERED 6. CONDUCT ORDERS Defendant is prohibited from further violence or threats of violence against the protected persons and SPECIFICALLY IT IS ORDERED THAT DEFENDANT x a. shall not assault, batter, or stalk the employee and other protected persons b. x shall not telephone or send correspondence to the employee and other protected persons by any means including, but not limited to, the use of the public or private mails, interoffice mail, fax, or computer e-mail x shall not take any action to obtain the address or location of the employee or the employee's family members or caretakers f. g. x shall not follow the employee and other protected persons during hours of employment e. 7. shall not follow or stalk the employee and other protected persons to or from the place of work x d. 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. x c. x shall not enter the workplace of the employee and other protected persons. other (specify): STAY AWAY ORDER Defendant shall stay at least (specify):_100___ yards away from the following places and persons (the addresses of the places are optional and may be kept confidential): a. x Employee and other protected person named in item 5. b. x Residence of employee and other protected persons (address optional): c. x Place of work of employee and other protected persons (address optional): d. x School or place of child care of children of employee and other protected persons (address optional): e. x f. The employee's and other protected persons' vehicles Other (specify): (address optional): 8. Contacts relating to pickup and delivery of children under a court order or a court-approved stipulation of the parties arrived at during mediation shall be permitted, unless a criminal domestic protective or restraining order prohibits such contacts. WV-120 [Rev. January 1, 2007] WV-150-INFO [Rev. January 1, 2007] ORDER TO SHOW CAUSE AND TEMPORARY RESTRAINING ORDER (CLETS) (Workplace Violence) Page 2 of 4 Page 10 of 12 WV-150-INFO Fill this in. Leave this blank. CASE NUMBER: PLAINTIFF (Name): Sarah Jones DEFENDANT (Name): John Roe 9. Item 11 lists the papers that must be personally served on the defendant. MANDATORY FIREARMS RELINQUISHMENT The restrained person must surrender to local law enforcement or sell to a licensed gun dealer any firearms in, or subject to, his or her immediate possession or control within 24 hours of being served with this order. If the restrained person owns, possesses, or controls any firearms, he or she must file a receipt with the court showing compliance with this order within 48 hours of receiving this order. (Form WV-145 is available for this purpose.) 10. OTHER ORDERS (specify): Continued on Attachment 10. x 11. SERVICE ON DEFENDANT The documents listed below must be personally served on the defendant: a. Order to Show Cause and Temporary Restraining Order (CLETS) (Workplace Violence) (form WV-120) Courts generally require that the defendant be served at least 5 days before the hearing. But the court may shorten the time. b. Petition of Employer for Injunction Prohibiting Violence or Threats of Violence Against Employee (Workplace Violence) (WV-100) c. Blank Response to Petition of Employer for injunction Prohibiting Violence or Threats of Violence Against Employee (Workplace Violence) (WV-110) d. Blank Proof of Service By Mail of Completed Response (Workplace Violence) (form WV-131) e. Blank Proof of Sale or Turning In of Firearms (form WV-145) f. Other (specify): 12. ORDER SHORTENING TIME Application for an order shortening time is granted and the documents listed in item 11 shall be personally served on the defendant by the date specified in item 4a. List the addresses of all law enforcement agencies that enforce the law where harassment has occurred or is likely to occur in the future. 13. DELIVERY TO LAW ENFORCEMENT By the 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 enforcement agencies listed below as follows: a. b. x Plaintiff shall deliver. Plaintiff’s attorney shall deliver. Law enforcement agency Address Anytown Police Department 100 Tuft Street, Anytown, California 91234 Anytown Police Department Government Hall, Big City, California 91235 Date: JUDICIAL OFFICER SIGNATURE FOLLOWS LAST ATTACHMENT This order is effective when made. It is enforceable anywhere in all 50 states, the District of Columbia, all tribal lands, and all U.S. territories and shall be enforced as if it were an order of that jurisdiction by any law enforcement agency that has received the order, is shown a copy of the order, or has verified its existence on the California Law Enforcement Telecommunications System (CLETS). Violations of this restraining order are subject to criminal penalties. After this order is signed by the judge, you or your attorney must take a copy of this order to the law enforcement agencies immediately if you want them to be able to enforce it. WV-150-INFO [Rev. January 1, 2007] NOTICE REGARDING FIREARMS Any person subject to a restraining order is prohibited from owning, possessing, purchasing or attempting to purchase, receiving or attempting to receive, or otherwise obtaining a firearm. Such conduct is subject to a $1,000 fine and imprisonment. The person must surrender to local law enforcement or sell to a licensed gun dealer any firearm in or subject to his or her immediate control in accordance with item 9 above. WV-120 [Rev. January 1, 2007] ORDER TO SHOW CAUSE AND TEMPORARY RESTRAINING ORDER (CLETS) (Workplace Violence) Page 3 of 4 Page 11 of 12 WV-150-INFO CASE NUMBER: PLAINTIFF (Name): DEFENDANT (Name): 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, you may file and serve declarations signed by persons who have personal knowledge of the facts. A declaration form (form MC-031) is available from the clerk’s office of the court shown on page one of this form. 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 who serves the plaintiff 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. 5. An instruction booklet entitled Instructions for Petitions to Prohibit Workplace Violence (form WV-150) is available from the clerk’s office at the court shown on page one of this form. Requests for Accommodations Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available upon request if at least 5 days notice is provided. Contact the clerk's office for Request for Accommodations by Persons With Disabilities and Order (form MC-410). (Civil Code section 54.8.) WV-120 [Rev. January 1, 2007] WV-150-INFO [Rev. January 1, 2007] ORDER TO SHOW CAUSE AND TEMPORARY RESTRAINING ORDER (CLETS) (Workplace Violence) Page 4 of 4 Page 12 of 12