Form Calhr 810 Be PDF Details

Much confusion and interest swirls around the new Form CalHR 810 that was released in December 2017. The form is used to report wage and hour violations, and many employers and employees are unsure of what is required. In this post, we'll break down the requirements of Form CalHR 810 so that everyone can be clear on what needs to be done. We'll also provide some tips on how to stay compliant with wage and hour laws in California. Stay tuned for our next post, where we'll discuss common wage and hour violations in more detail!

QuestionAnswer
Form NameForm Calhr 810 Be
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesCalHR 810 BE calhr bilingual exams form

Form Preview Example

California Department of Human Resources

Oral Bilingual Proficiency Examination Request Form

Bilingual Services Program (BSP)

CalHR-810-BE (Rev. 10/2012)

EXAM REQUEST 1:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

 

 

 

 

 

FIRST NAME

 

 

 

 

WORK PHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (for Exam Results)

 

 

 

CONFIRM EXAM DATE & TIME

TO

 

LANGUAGE

 

 

Address:

 

 

 

 

 

 

 

EMPLOYEE BY:

 

EXAM:

 

 

City:

State:

Zip Code:

E-Mail Address:

 

 

 

 

 

or

 

 

 

 

 

 

 

 

 

 

 

 

Fax Number:

 

 

 

 

EXAM REQUEST 2:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

WORK PHONE NUMBER (Ext .)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (for Exam Results)

 

 

 

CONFIRM EXAM DATE & TIME TO

 

LANGUAGE

 

 

Address:

 

 

 

 

 

 

 

EMPLOYEE BY:

 

EXAM:

 

 

City:

State:

Zip Code:

E-Mail Address:

 

 

 

 

 

or

 

 

 

 

 

 

 

 

 

 

 

 

Fax Number:

 

 

 

 

EXAM REQUEST 3:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

 

 

FIRST NAME

 

WORK PHONE NUMBER (Ext .)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (for Exam Results)

 

 

 

CONFIRM EXAM DATE & TIME TO

 

LANGUAGE

 

 

Address:

 

 

 

 

 

 

 

EMPLOYEE BY:

 

EXAM:

 

 

City:

State:

Zip Code:

E-Mail Address:

 

 

 

 

 

or

 

 

 

 

 

 

 

 

 

 

 

 

Fax Number:

 

 

 

 

SUPERVISOR’S CONTACT INFORMATION:

 

 

 

 

 

 

 

 

 

NAME:

 

 

 

 

 

 

 

 

 

TITLE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (for Exam Results)

 

 

 

CONTACT NUMBER1:

Ext.

 

 

Department:

 

 

 

 

 

 

 

ALTERNATE NUMBER:

Ext.

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

State:

Zip Code:

 

 

 

 

 

 

 

 

 

CONFIRM EXAM DATE & TIME TO SUPERVISOR BY:

 

 

 

 

 

 

 

 

 

E-Mail Address:

 

 

 

 

 

 

 

or Fax Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REASONABLE ACCOMMODATIONS (Please Specify):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXAM REQUESTED BY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REQUESTOR’S NAME:

 

 

 

 

 

TITLE:

 

 

 

TELEPHONE NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ext.

 

 

 

 

 

 

 

 

 

 

 

 

 

E-MAIL ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYMENT IS DUE PRIOR TO EXAM BEING SCHEDULED (NO CASH OR PERSONAL CHECKS CAN BE ACCEPTED)

1The employee’s supervisor must be available at the listed contact number to verify the identity of the employee being tested, prior to starting the examination. If the supervisor and candidate are to be reached at a different number than the contact number, please list as an alternative number. In addition, if we are unable to reach you within 15 minutes of the scheduled start time of the exam the candidate will need to reschedule.

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California Department of Human Resources

Oral Bilingual Proficiency Examination Request Form

Bilingual Services Program (BSP)

CalHR-810-BE (Rev. 10/2012)

 

PAYMENT METHOD:

 

 

 

 

 

 

 

 

 

 

Mail Payment & Request Form To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$115.00/ea. - Purchase/Service Order #

 

 

(Attached)

 

CalHR – Office of Civil Rights

*

 

 

 

 

 

 

 

 

 

 

 

 

$115.00/ea. - Bill Consolidated Contract #

 

 

 

*

 

 

Bilingual Services Program

 

 

 

 

$115.00/ea. – Cashier’s Check or Money Order Enclosed

 

Attn: Bilingual Testing Coordinator

 

 

1515 S Street, North Bldg., Ste. 400

 

(California Department of Human Resources)

 

 

$115.00/ea. – Cal Card or Credit Card*

 

 

 

 

 

 

Sacramento, CA 95811-7258

 

 

 

 

 

 

 

For Information or Questions:

 

 

x$_

=$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(916) 324-0970

 

 

# of Exams

Cost Per Exam

Total Cost

 

 

 

 

Fax: (916) 327-2349

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*IF PAYING BY CONSOLIDATED CONTRACT OR PURCHASE/SERVICE ORDER, PLEASE INCLUDE THE FOLLOWING

 

 

INFORMATION.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of person to invoice:

 

 

 

 

 

 

Unit:

 

 

 

Address:

 

 

 

 

City:

 

State:

Zip Code:

 

Phone number:

 

 

 

 

 

 

 

 

Fax number:

 

 

 

*IF PAYING BY CREDIT CARD/CAL CARD:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of the Candidate(s) for which this payment should be applied:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of Exams

 

Item Description

 

 

Cost Per Item

Total Cost to be Charged

 

 

 

 

 

Bilingual Oral Fluency

 

$115.00

 

 

 

 

 

 

 

Examination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Card

Information

 

 

 

Name of Card Holder (as it appears on the credit card):

 

 

 

 

 

 

 

 

 

 

 

 

Type of Credit Card:

Cal Card

Visa

MasterCard

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Card #:

 

 

 

 

 

 

Expiration Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (to send receipt):

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

City:

 

State:

Zip:

Contact Telephone Number:

I Hereby Authorize the Department of Human Resources to charge my credit card for the total cost of administering the above bilingual oral fluency exam(s).

Signature of Card Holder:

THE EMPLOYEE AND SUPERVISOR WILL RECEIVE CONFIRMATION BY E-MAIL OR FAX, APPROXIMATELY 7 DAYS FROM THE DATE THE EXAMINATION IS SCHEDULED. NO EXAMINATION WILL BE SCHEDULED UNTIL THE CHECK OR PAYMENT AUTHORIZATION IS RECEIVED.

I hereby certify that I am authorized to submit a request for bilingual fluency examination, as or on behalf of, the department’s testing officer.

Signed:

Title:

Date:

 

 

 

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