Farm Labor Contractor Short-Form License Renewal Application
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3STATE OF CALIFORNIA
EDMUND G. BROWN JR., Governor
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF LABOR STANDARDS ENFORCEMENT
MAILING ADDRESS:
Licensing & Registration Unit
P. O. Box 420603
1515 Clay Street, Suite 401
San Francisco, CA 94142-0603
Oakland, CA 94612
Tel: (510) 285-3399 Fax: (510) 286-1366
FARM LABOR CONTRACTOR
SHORT-FORM LICENSE RENEWAL APPLICATION
Requirements for Short-Form Renewal
Your farm labor contractor license may now be renewed using the Short-Form application if you meet ALL of the following four
conditions:
1.
Since your previous application, there have been no changes in your business entity status or information, which includes
the following:
•
No change in form of legal entity (including no change in the partners, corporate officers, members of LLC or
the sole proprietor).
•
No change in legal entity identifying information previously provided (including business name(s); full
name(s) of the sole proprietor, partners, corporate officers, or LLC members, whichever is applicable;
address(es); telephone number(s); and percentage of interest of all persons with a financial and/or profit-sharing
interest in your business).
AND
2.
You have no outstanding civil citations, unpaid penalties or delinquent unpaid wages, you have filed all required
tax returns, and you have no outstanding personal or employment tax liabilities. (If you do have delinquent unpaid
wages, unpaid penalties and/or other outstanding liabilities, your application for automatic renewal will not be approved.)
AND
3.
No person (sole proprietor, partner, corporate officer or LLC member) has plead guilty or nolo contendere to or been
convicted of a crime substantially related to working conditions or worker’s health or safety, either misdemeanor or
felony, within the last 10 years.
AND
4.
No person (sole proprietor, partner, corporate officer or LLC member) has been found guilty, or hired any supervisorial
personnel who have been found guilty, by either a court or administrative agency, of having committed sexual harassment
in the workplace in the preceding three years.
If you do NOT meet these four conditions, complete the regular renewal application (Renewal Application for Farm Labor
Contractor License (DLSE 401-R).
If you meet these four conditions, please comply with the items below and attach the required documentation to this letter.
Fees
You must remit a renewal fee of $600, plus a $10 filing fee, and an additional $184 if an exam is required pursuant to Labor Code
sections 1684(a)(5) and 1684(c) no later than 60 days before expiration of the current license. If the renewal application is received
timely (60 days or more prior to the expiration date of the current FLC license), the $10 filing fee is not required.
Required Documents
Provide the following documents:
1.
Pursuant to Labor Code section 1684(a)(3), an original Farm Labor Contractor Bond (DLSE 402) (only if there has
been a change in the amount based on the size of your annual payroll)
2.
Pursuant to Labor Code section 3700, copy of valid and current Workers’ Compensation Insurance policy certificate.
3.
For each farm labor vehicle used to transport farm laborers in connection with your business activities or operations, a
copy of current proof of automobile liability insurance which shows the following: the name and address of the
coverage carrier; policy number; effective and expiration dates of the policy; and coverage limits (including medical
coverage) in an amount sufficient to afford adequate coverage of all employees transported in the event of an accident
(see Title 8, California Code of Regulations, section 13361(b)(2)(C)(iii)).
4.
For each individual who will operate any vehicle to provide transportation of farm laborers in connection with your
business activities or operations, if there has been a change in any such driver(s): copy of driver’s license; copy of
Department of Motor Vehicles (DMV) certificate to permit operation of farm labor vehicle; and evidence of clear
driving record from the DMV.
DLSE 401-S (Rev. 01/2015)
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