Waiver Application - Payment of Minimum Wage
Dec 28, 2024
submission
#72
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 - Declare Bankruptcy or Shutdown
| Submit a memo stating the business’ current financial status and how Ordinance No. 21-1168 for payment of a minimum wage will force the business to declare bankruptcy or be shutdown | --- |
| Submit a copy of the written notice sent to all Employees informing them of the business’ application for a waiver | --- |
| Submit the business’ State and Federal Tax Returns for the most recent three filed calendar years | --- |
| Submit business lease (if applicable) | --- |