Application For Special Minimum Wage License (Labor Code Section 1191) {DLSE 106}

DLSE 106 - APPLICATION FOR SPECIAL MINIMUM WAGE LICENSE (Labor Code section 1191), This form is used in California to request authorization to pay a special minimum wage to an individual with a disability under Labor Code section 1191. The form is jointly completed by the employer and the worker (or the worker’s parent or legal guardian, if applicable) and is administered by the Department of Industrial Relations, Division of Labor Standards Enforcement (DLSE). The application collects detailed information about the establishment, the worker with a disability, any referring organization, the nature of the disability, and the proposed wage rate. Employers must document work measurement methods, productivity evaluations, and prevailing wage surveys to justify the requested wage. The form is used for new licenses or renewals and must be submitted with required attachments and certifications. www.FormsWorkflow.com