FOR ENFORCEMENT OFFICE USE ONLY 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part 1: Employee Information. Fill in your name, date, email, phone number, and mailing address. This information is crucial for the Enforcement Office to process your complaint efficiently.
3. Proceed to Part 2: Employer Information. Enter the business name, business address, where you worked, and details of the manager or owner including their name and email. This helps identify the employer involved in your complaint.
4. In Part 3: Jurisdiction/Complaint, confirm if you worked at least 2 hours within San Diego limits by selecting 'Yes' or 'No'. Specify the claim period and check all applicable types of complaints regarding paid sick leave or minimum wage notices.
5. Provide your hourly wage and number of paid sick days received. Indicate how you are paid (check, cash, etc.) and include any additional information that supports your claim.
6. Finally, attach any relevant documentation that substantiates your claim. Sign and date the form before submitting it via email, fax, or mail as indicated.

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