WV-140 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY FAX NO. (Optional): TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF: DEFENDANT: EMPLOYEE: CASE NUMBER: ORDER AFTER HEARING ON PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (CLETS) 1. THIS ORDER SHALL EXPIRE AT MIDNIGHT ON (date): IF NO DATE IS PRESENT, THIS ORDER EXPIRES THREE YEARS FROM THE DATE OF ISSUANCE. 2. This proceeding came on for hearing as follows: Date: Time: 3. Judge (name): 4. a. Plaintiff present b. Defendant present Dept.: Room: Temporary judge Attorney present (name): Attorney present (name): THE COURT FINDS 5. a. The defendant is (name): Sex: F Ht.: M Wt.: Hair color: Eye color: Race: Age: Date of birth: b. The protected employee is (name): Sex: M F Date of birth: c. Protected family or household members who reside with employee are: (1) (Name): Sex : M F Date of birth: M F Date of birth: M F Date of birth: (2) (Name): Sex: (3) (Name): Sex: Continued on Attachment 5c. Page 1 of 3 Form Adopted for Mandatory Use Judicial Council of California Approved by DOJ WV-140 [Rev. January 1, 2007] ORDER AFTER HEARING ON PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (CLETS) (Workplace Violence) Code of Civil Procedure, §§ 527.8 and 527.9; Penal Code, § 273.6(a) www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com WV-140 CASE NUMBER: PLAINTIFF (Name): DEFENDANT (Name): EMPLOYEE (Name): THE COURT ORDERS 6. PERSONAL CONDUCT ORDERS Defendant is prohibited from further violence or threats of violence against the employee listed in item 5b and the protected persons listed in item 5c. Specifically, 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 shall not telephone or send correspondence to the employee and other protected persons by any means d. including, but not limited to, the use of the public or private mails, interoffice mail, fax, or computer e-mail shall not take any action to obtain the address or location of the employee or any of the employee's family members e. or caretakers f. shall not enter the workplace of the employee and other protected persons g. other (specify): 7. STAY AWAY ORDERS a. Defendant is ordered to stay at least (specify): yards away from the following persons and places (the addresses of the places are optional and may be kept confidential): (1) Employee and other protected persons named in item 5c. (2) (3) Place of work of employee and other protected persons (address optional): (4) School or place of child care of children of employee or other protected persons (address optional): (5) (6) b. Residence of employee and other protected persons (address optional): Vehicles of employee and other protected persons. Other (specify): Contacts relating to pickup and delivery of children under a court order or a court-approved stipulation of the parties arrived at during mediation are permitted, unless a criminal protective or other restraining order prohibits such contacts. WV-140 [Rev. January 1, 2007] ORDER AFTER HEARING ON PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (CLETS) (Workplace Violence) Page 2 of 3 WV-140 CASE NUMBER: PLAINTIFF (Name): DEFENDANT (Name): EMPLOYEE (Name): 8. MANDATORY FIREARM RELINQUISHMENT ORDER 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.) 9. OTHER ORDERS (specify): Continued on Attachment 9. 10. 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. Plaintiff shall deliver. Plaintiff’s attorney shall deliver. b. Law enforcement agency Address Date: JUDICIAL OFFICER INSTRUCTIONS FOR LAW ENFORCEMENT 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. 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 possession or control in accordance with item 8 above. WV-140 [Rev. January 1, 2007] ORDER AFTER HEARING ON PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (CLETS) (Workplace Violence) Page 3 of 3