Form LIC9052 Notice Employee Rights - California

When to Use LIC 9052 Form?

Form LIC 9052 notifies an employee about their protection from demotion, suspension, discharge, or the threat thereof for the following actions:

• Complaining orally or in writing against the employer to the CDSS, other agency statutory responsible for enforcement of the law, or the employer's representative for various violations of any laws. The notice specifically mentions child abuse and staff-to-child ratios, but it is possible to complain about the violation of any licensing law or other regulations;
• Filing a suit or causing such a filing against an employer with regard to the violation of the law;
• Witnessing or testifying in proceedings regarding the violation of the law;
• Refusing to perform work responsibilities that violate law once the employer was notified of this violation.

If an employee believes their employer has unlawfully demoted, suspended, discharged them, or threatened to do any of the above, it is necessary to do the following:

1. Submit a claim to the employer to allege a violation of the employee's rights within forty-five days after the violation has taken place.
2. File a claim with the Division of Labor Standards Enforcement (DLSE) within ninety days of the employer violating the law. Once the complaint is received, the DLSE investigates the claim and will take action against the employer in the appropriate court.

When to Sign the LIC 9052 Form?

The LIC Notice of Employee Rights is signed before an employee starts work. The employee must sign this form, identify the employer, name the facility, and write down the actual date of signing. Then, the bottom of the form that contains the signature is detached and kept in the employee's personnel file, while the employee receives instructions forpersonal use. If an employee refuses to sign the notice, prepare a dated notation to that effect and retain it with the employee's personnel record.