Form Dlse 351 PDF Details

Form DLSE 351 is a document that businesses in California use to report information about their employees. This form is used for a variety of purposes, including recording wages and hours worked, calculating employer contributions to employee benefits, and more. Knowing how to complete this form correctly is essential for businesses in California. In this blog post, we'll provide an overview of the information that needs to be reported on Form DLSE 351. We'll also discuss some tips for completing the form accurately.

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QuestionAnswer
Form NameForm Dlse 351
Form Length2 pages
Fillable?Yes
Fillable fields64
Avg. time to fill out13 min 22 sec
Other namesexpungement, REVOCATION, seq, talent agent license

Form Preview Example

Return Application To:

State of California

DLSE Licensing

Department Of Industrial Relations

1515 Clay Street, Suite 1902

DIVISION OF LABOR STANDARDS ENFORCEMENT

Oakland, CA 94612

 

(510) 285-3397

 

TALENT AGENCY LICENSE APPLICATION

Application is hereby made pursuant to Labor Code sections 1700, et seq., California Code of Regulations, Title 8, Subchapter 3, Sections 12000- 12006 and the applicable Industrial Welfare Commission Order, for a license to carry on the business of a talent agency. PLEASE CAREFULLY

READ THE ACCOMPANYING EXPLANATION OF REQUIREMENTS PRIOR TO COMPLETING THIS APPLICATION. AN INCOMPLETE APPLICATION, INCLUDING INCOMPLETE SUBMISSION OF REQUIRED SUPPORTING DOCUMENTATION, WILL DELAY THE ISSUANCE OF YOUR LICENSE.

1.

Name of legal entity applying for a license:

 

 

 

 

 

2.

This is an application for a:

 

 

 

 

 

 

 

 

 

New

Renewal

3.

DBA (Doing Business As):

 

 

 

 

 

4.

If renewal, give previous license #:

 

 

 

 

 

 

 

 

 

5.

Main office address (number, street, city, state, zip code):

 

 

 

6.

Business telephone:

 

 

 

 

 

 

 

 

 

7.

Branch office address (number, street, city, state, zip code):

 

 

 

8.

Branch business telephone:

 

 

 

 

 

 

 

 

 

9.

Type of ownership (Please check one):

 

 

 

 

 

10.

Birth date (See Instructions):

 

Individual

Partnership

Corporation

LLC

 

 

 

 

 

11.

If individual, give full name and residence address of owner:

 

 

 

Home telephone:

 

 

 

 

 

 

 

 

12.

If partnership, corporation, or LLC, give full name and residence address of each partner,

 

Home telephone:

 

 

corporate officer, or LLC member (use additional sheet if necessary):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

Date incorporated:

 

 

14. State in which incorporated:

15.

If a

foreign corporation, give date Articles of

 

 

 

 

 

 

Incorporation were filed with the California Secretary

 

 

 

 

 

 

of State:

 

 

16. Name, residence address and percentage of interest of each partner or member of LLC having a financial interest in the business. If corporation, include only those having a financial interest of 10% or more. Omit if Individual ownership:

DO NOT WRITE BELOW THIS LINE – PLEASE COMPLETE REVERSE SIDE

Application Number:

Approved

State Labor Commissioner

By: _____________________

BF/C

P/RP/C

A/CF/S

CON WCI

___________________

Amount Received

__________________

Postmark Date

__________________

Effective Date

__________________

Check Number

_________________

Date Mailed

__________________

Expiration Date

DLSE 351 (Rev. 3/19)

1

State of California

TALENT AGENCY LICENSE

 

Department of Industrial Relations

APPLICATION

Division of Labor Standards Enforcement

17.Name, residence address and position of each person with responsibility and authority to manage the business:

18.Name, residence address and percentage of profit sharing of each person with profit sharing interest in the business (exclude bona fide employees on stated salaries:

19. Will the business of this talent agency be conducted in connection with any other business?

Yes

No

If yes, indicate the kind of business and circumstances (use separate sheet if necessary):

 

 

20. Does the talent agency or any of the persons names in Items 11, 12 or 16 presently:

(a) Owe any unpaid wages?

Yes

No

 

(b) Have any unpaid outstanding judgments?

Yes

No

If yes to either, indicate the kind of business and explain the circumstances (use separate sheet if necessary):

21. Have any of the persons listed in items 11, 12 or 16 ever been convicted1 of a crime, either misdemeanor or felony?

Yes No

If yes, indicate the name of the person, the date, the place and explain the circumstances for each crime (use separate sheet if necessary). Attach

documentation to indicate disposition.

22. Will the talent agency have sub-agents or any other employees? Yes No

If yes, complete Items 23, 24 and 25 below and attach a copy of the Workers Compensation Certificate of Insurance

23. Name of Workers’ Compensation Insurance carrier:

24. Policy Number:

25. Period covered:

 

 

From:

To:

CERTIFICATION

I am/We are aware of and agree to comply with the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for workers’ compensation.

I/We, under penalty of perjury, confirm that I/We will comply with Section 1700.53 of the Labor Code not later than June 30, 2019, and understand that the Labor Commissioner may at any time conduct an inspection to ensure compliance with Sections 1700.50 and 1700.51.

I/We agree to operate as a talent agency in compliance with the provisions of the California Labor Code and with the Rules and Regulations issued by the Labor Commissioner of the State of California.

I/We hereby certify, under penalty of perjury, that the foregoing statements are true and correct and that I am/we are aware of the fact that ANY

MATERIAL MISREPRESENTATION IS GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF A LICENSE.

Executed at 2 ______________________________________ California, this ______ day of _________________________, 20 _____

Signatures: (Individual owner, each partner or each LLC member must sign; if corporation, any authorized corporate officer may sign. He/She must show his/her title and submit a copy of Articles of Incorporation and Statement by Domestic Stock Corporation)

Printed name and title

Signature

Printed name and title

Signature

1The term “convicted” includes instances in which suspension of sentence was had and probation granted, and where expungement proceedings under Penal Code section 1203.4 and the following were undertaken.

2If place of execution is outside California, the foregoing statements must be sworn to before a notary public or other officer authorized to take oaths and affirmations.

DLSE 351 (Rev. 3/19)

2

How to Edit Form Dlse 351 Online for Free

We were creating the PDF editor having the prospect of making it as quick to use as it can be. Therefore the entire process of filling out the DBA will likely to be effortless perform the next actions:

Step 1: Press the "Get Form Now" button to begin the process.

Step 2: Now you may edit your DBA. You should use our multifunctional toolbar to insert, eliminate, and modify the content of the document.

You should provide the next details so that you prepare the document:

part 1 to completing Subchapter

Provide the requested particulars in the section ApplicationNumber, Approved, StateLaborCommissioner, CON, WCI, AmountReceived, PostmarkDate, EffectiveDate, DLSERev, CheckNumber, DateMailed, and ExpirationDate.

step 2 to finishing Subchapter

Indicate the essential information in onstatedsalaries, and Yes segment.

Subchapter onstatedsalaries, and Yes fields to insert

Within the box PolicyNumber, Periodcovered, FromCERTIFICATION, ExecutedatCaliforniathisdayof, Printednameandtitle, Printednameandtitle, Signature, and Signature, specify the rights and responsibilities of the sides.

Entering details in Subchapter part 4

Step 3: Click the "Done" button. It's now possible to export your PDF file to your electronic device. Aside from that, you'll be able to forward it via electronic mail.

Step 4: To protect yourself from any sort of complications as time goes on, try to generate as a minimum two or three duplicates of the file.

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