Waiver Application - Payment of Minimum Wage
May 28, 2022
submission
#6
Business Information
Employer Business Information
| Business Name | --- |
| Business Phone Number | --- |
| Business Mailing Address | --- |
| Business Location Address | --- |
| Total Number of Employees | --- |
| Business Type | --- |
| Total number of businesses you have within the County of Los Angeles | --- |
| Total number of businesses you have within the City of West Hollywood | --- |
Workforce Information
| Reason for Waiver Request | --- |
Supporting Documentation
Required Supporting Documentation - Reduce Workforce by More Than Twenty Percent
| Submit the business’ State and Federal Tax Returns for the most recent three filed calendar years | --- |
| Submit all four (4) quarters of IRS Form 941 for 2019, 2020, and 2021 | --- |