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Temporary Restraining Order (CLETS-TWH) (Workplace Violence Prevention) WV-110 - California
| Temporary Restraining Order (CLETS-TWH) (Workplace Violence Prevention) Form. This is a California form and can be used in Workplace Violence Judicial Council . |
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WV-110 1 a. Temporary Restraining Order Clerk stamps date here when form is filed. Petitioner (Employer) Name: Lawyer for Petitioner (if any for this case): Name: State Bar No.: Firm Name: Address (If you have a lawyer, give your lawyer's information.): Address: City: Telephone: E-Mail Address: State: Fax: Zip: Fill in court name and street address: b. Superior Court of California, County of 2 Employee (Protected Person) Full Name: Court fills in case number when form is filed. Case Number: 3 Respondent (Restrained Person) Full Name: Description: Sex: M F Height: Weight: Eye Color: Date of Birth: Age: State: Race: Zip: Hair Color: Home Address (if known): City: Relationship to Employee: 4 Additional Protected Persons In addition to the employee, the following family or household members or other employees are protected by the temporary orders indicated below: Sex Age Household Member? Relation to Employee Full Name Yes Yes Yes No No No Additional protected persons are listed at the end of this Order on Attachment 4. 5 Expiration Date This Order expires at the end of the hearing scheduled for the date and time below: Date: Time: a.m. p.m. This is a Court Order. Judicial Council of California, www.courts.ca.gov Revised January 1, 2012, Mandatory Form Code of Civil Procedure, ยงยง 527.8 and 527.9 Approved by DOJ Temporary Restraining Order (CLETS-TWH) (Workplace Violence Prevention) WV-110, Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: To the Respondent: The court has issued the temporary orders checked as granted below. If you do not obey these orders, you can be arrested and charged with a crime. You may have to go to jail for up to one year, pay a fine of up to $1,000, or both. 6 Personal Conduct Orders Not Requested Denied Until the Hearing Granted as Follows: a. You are ordered not to do the following things to the employee and to the other protected persons listed in 4 : (1) Harass, molest, strike, assault (sexually or otherwise, batter, abuse, destroy personal property of, or disturb the peace of the person. (2) (3) (4) Commit acts of violence or make threats of violence against the person. Follow or stalk the person during work hours or to or from the place of work. Contact the person, directly or indirectly, by any means, including but not limited to, in person, by telephone, in writing, by public or private mail, by interoffice mail, by text message, by e-mail, by fax, or by other electronic means. Enter the workplace of the person. Take any action to obtain the person's addresses or locations. If this item 6 is not checked, the court has found good cause not to make this order. Other (specify): Other personal conduct orders are attached at the end of this Order on Attachment 6a(7). (5) (6) (7) 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. However, you may have your papers served by mail on the petitioner. 7 Stay-Away Order Not Requested a. You must stay at least (1) (2) (3) (4) (5) (6) Denied Until the Hearing Granted as Follows: yards away from (Check all that apply): (7) (8) (9) The employee's children's place of child care The employee's vehicle Other (specify): The employee Each other protected person listed in 4 The employee's workplace The employee's home The employee's school The employee's children's school 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, 2012 Temporary Restraining Order (CLETS-TWH) (Workplace Violence Prevention) WV-110, Page 2 of 6 Case Number: 8 No Guns or Other Firearms and Ammunition 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. 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 that your guns or firearms 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 possess a firearm. 9 Other Orders Not Requested Denied Until the Hearing Granted as Follows (specify): Additional orders are attached at the end of this Order on Attachment 9. To the Petitioner: 10 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. c. The clerk will transmit this Order and its proof-of-service form to a law enforcement agency to be entered into CLETS. By the close of business on the date that this Order is made, the employer or the employer's lawyer should deliver a copy of the Order and its proof-of-service form to the law enforcement agencies listed below to enter into CLETS: Name of Law Enforcement Agency Address (City, State, Zip) Additional law enforcement agencies are listed at the end of this Order on Attachment 10. 11 No Fee to Serve (Notify) Restrained Person Ordered Not Ordered The sheriff or marshal will serve this Order without charge because: The Order is based on unlawful violence, a credible threat of violence, or stalking. a. b. The petitioner is entitled to a fee waiver. This is a Court Order. Revised January 1, 2012 Temporary Restraining Order (CLETS-TWH) (Workplace Violence Prevention) WV-110, Page 3 of 6 Case Number: 12 Number of pages attached to this Order, if any: Date: Judicial Officer Warnings 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 8 above. The court will require you to prove that you did so. Notice Regarding Nonappearance at Hearing and Service of Order If you have been personally served with this Temporary R
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