WV-130 1 Restraining Order After Hearing to Stop Workplace Violence Clerk stamps date here when form is filed. Petitioner (Employer) Name: Attorney for Petitioner (if any): Name: State Bar No.: Firm Name: Street Address: State: Fax: City: Telephone: Fill in court name and street address: Zip: Superior Court of California, County of E-mail: 2 Employee in Need of Protection Full Name: 3 Court fills in case number when form is filed. Case Number: Respondent (Person From Whom Protection Is Sought) Full Name: Description: Sex: M F Height: Hair Color: Home Address (if known): Weight: Eye Color: Date of Birth: Age: City: 4 Race: Zip: State: Additional Protected Persons In addition to the employee, the following family or household members or other employees are protected by the orders indicated below: Sex Age Household Member? Relation to Employee Full Name Yes No Yes No Yes No Yes No Additional protected persons are listed at the end of this Order on Attachment 4. 5 Expiration Date This Order expires at: (time): a.m. p.m. or midnight on (date): If no expiration date is written here, this Order expires three years from the date of issuance. This is a Court Order. Judicial Council of California, www.courts.ca.gov Revised January 1, 2011, Mandatory Form Code of Civil Procedure, §§ 527.8 and 527.9 Approved by DOJ Restraining Order After Hearing to Stop Workplace Violence (CLETS-WHO) WV-130, Page 1 of 4 (Workplace Violence Prevention) American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 6 Hearing There was a hearing on (date): (Name of judicial officer): at (time): a.m. p.m. in Dept.: Room: made the orders at the hearing. These people were at the hearing: a. The petitioneremployer represented by (name): b. The lawyer for the petitioner/employer (name): c. The employee d. The lawyer for the employee (name): e. The respondent f. The lawyer for the respondent (name): Additional persons present are listed at the end of this Order on Attachment 6. 7 The hearing is continued. The parties must return to court on (date): at (time): To the Respondent The court has issued the orders checked as granted below. If you do not obey these orders, you can be arrested and charged with a crime. You may be sent to jail for up to one year, pay a fine of up to $1,000, or both. 8 Granted Personal Conduct Orders Not Granted Not Requested a. You are ordered not to: (1) assault, batter, or stalk the employee and other protected persons. commit acts of violence or make threats of violence against the employee and other protected persons. (2) (3) (4) (5) (6) (7) follow or stalk the employee and other protected persons during work hours or to or from the place of work. contact the employee and other protected persons, directly or indirectly, by any means, including but not limited to, in person, by telephone, in writing, by public or private mail, by e-mail, by fax, or by other electronic means. enter the workplace of the employee and other protected persons. take any action to obtain the employee’s and other protected persons’ addresses or locations. other (specify): b. Peaceful written contact through a lawyer or a process server or other person for service of legal papers related to a court case is allowed and does not violate this order. 9 Stay-Away Order Granted a. You must stay at least (specify): (check all that apply): Not Granted Not Requested yards away from the employee and other protected persons and (1) (2) the employee’s and other protected persons’ homes the employee’s and other protected persons’ jobs or workplaces (3) (4) (5) the employee’s and other protected persons’ vehicles the employee’s and other protected persons’ schools other (specify): b. This stay-away order does not prevent you from going to or from your home or place of employment. This is a Court Order. Revised January 1, 2011 Restraining Order After Hearing to Stop Workplace Violence (CLETS-WHO) (Workplace Violence Prevention) WV-130, Page 2 of 4 Case Number: 10 Firearms Prohibition and Relinquishment a. You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other firearms, or ammunition. b. If you have not already done so, you must: (1) Sell to a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms in your immediate possession or control. This must be done within 24 hours of being served with this Order. (2) File a receipt with the court within 48 hours of receiving this Order that proves guns have been turned in or sold. (You may use Form WV-800, Proof of Firearms Turned In or Sold, for the receipt.) c. The court has received information that you own or possesses a firearm. 11 Other Orders (specify): Granted Not Granted Not Requested Additional orders are attached at the end of this Order on Attachment 11. 12 Mandatory Entry of Order Into CARPOS Through CLETS This Order must be entered into the California Restraining and Protective Orders System (CARPOS) through the California Law Enforcement Telecommunications System (CLETS). (Check one): a. The clerk will enter this Order and its proof-of-service form into CLETS. b. The clerk will transmit this Order and its proof-of-service form to a law enforcement agency to be entered into CLETS. c. By the close of business on the date that this Order is made, you or your lawyer should deliver a copy of the Order and its proof-of-service form to the law enforcement agency listed below to enter into CLETS: Name of Law Enforcement Agency 13 Address (City, State, Zip) No Fee to Serve (Notify) Restrained Person Ordered Not Ordered The sheriff or marshal will serve this Order without charge because: a. The Order is based on a credible threat of violence or stalking. b. The petitioner is entitled to a fee waiver. 14 Number of pages attached to this Order, if any: Date: Judicial Officer This is a Court Order. Revised January 1, 2011 Restraining Order After Hearing to Stop Workplace Violence (CLETS-WHO) (Workplace Violence Prevention) WV-130, Page 3 of 4 Case Number: Warning and Notice to the Respondent You Cannot Have Guns or Firearms You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise get guns, other firearms, or ammunition while this Order is in effect. If you do, you can go to jail and pay a $1,000 fine. You must sell to a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms that you have or control as stated in item 10 . The court will require you to prove that you did so. If you do not obey this Order, you can be charged with a crime. 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). If the law enforcement agency has not received proof of service on the restrained person, and the restrained person was not present at the court hearing, the agency shall advise the restrained person of the terms of the Order and then shall enforce it. Violations of this Order are subject to criminal penalties. (Clerk will fill out this part.) —Clerk’s Certificate— Clerk’s Certificate [seal] I certify that this Restraining Order After Hearing to Stop Workplace Violence is a true and correct copy of the original on file in the court. Date: Clerk, by , Deputy This is a Court Order. Revised January 1, 2011 Restraining Order After Hearing to Stop Workplace Violence (CLETS-WHO) (Workplace Violence Prevention) WV-130, Page 4 of 4