DLSE Form 403 is the Farm Labor Contractor Supervisory Employee Sexual Harassment Disclosure Statement, a one-page sworn declaration each supervisor of a California farm labor contractor signs to attest that no court or administrative agency has found them to have committed sexual harassment within the previous three years.1Department of Industrial Relations. Supervisory Employee Sexual Harassment Disclosure Statement It goes into the contractor’s license application package, both for new licenses and renewals.
Who Has to Sign One
Every supervisory employee who directs or controls agricultural workers needs their own signed form. Labor Code Section 1685 covers supervisors, crew leaders, mayordomos, forepersons, and anyone else in a supervisory role over agricultural workers.2California Legislative Information. California Code, Labor Code – LAB 1685 Five supervisors means five separate forms. The contractor collects them all and submits them with the license paperwork.
The requirement applies equally to new applicants and to contractors renewing an existing license. DLSE’s renewal checklist lists the disclosure statement alongside the renewal application, bond, and training records.3Department of Industrial Relations. Farm Labor Contractor License Renewal
How to Fill Out the Form
Download the current version, DLSE 403 (REV. 01/2015), as a PDF from the California Department of Industrial Relations.1Department of Industrial Relations. Supervisory Employee Sexual Harassment Disclosure Statement The attestation language is pre-printed. You only fill in the blanks:
- Employee name — the supervisor’s full legal name.
- Title — the job title, such as foreperson, crew leader, or field supervisor.
- Farm Labor Contractor Employer — the name of the contractor or business entity that employs the supervisor.
- Executed at — the California city where the form is being signed.
- Date fields — the day, month, and year of signing.
- Employee signature — the supervisor’s handwritten signature.
- Printed name and title — repeated below the signature line.
The pre-printed declaration reads: “I have not been found to have committed sexual harassment by any court or any administrative agency within three years prior to the date this statement is executed.” Signing it makes that statement under penalty of perjury. There is nothing to edit in the attestation itself.
Submitting the Form
Form 403 is never filed on its own. It travels with the farm labor contractor license application, surety bond, examination fee, and the other required documents. Every person engaged in farm labor contracting in California must register with the Labor Commissioner’s Office.4Department of Industrial Relations. Farm Labor Contractors License
New applicants can apply online through DLSE’s FLC application portal or submit a paper package. Paper filings go to one of two offices depending on where you operate. Applicants in Kern, Tulare, Fresno, Merced, Kings, and Madera counties file with the DLSE Licensing and Registration Unit at 770 East Shaw Ave., Suite 222, Fresno, CA 93710. Everyone else files with the Licensing and Registration Unit at 1515 Clay Street, Suite 1902, Oakland, CA 94612. Questions can go to FLC@dir.ca.gov.4Department of Industrial Relations. Farm Labor Contractors License
At renewal, include a current, signed Form 403 for every supervisor on staff, along with the training records DLSE requires in the renewal package.3Department of Industrial Relations. Farm Labor Contractor License Renewal
What Happens If the Declaration Is False
The form warns in bold that a material misrepresentation is grounds for denial or revocation of the license.1Department of Industrial Relations. Supervisory Employee Sexual Harassment Disclosure Statement If a supervisor signs Form 403 claiming a clean record while a qualifying court or agency finding actually exists against them within the past three years, the Labor Commissioner can deny a pending application or revoke an existing license.
The signer also faces personal exposure. A false sworn declaration can carry perjury consequences under California law. And operating as a farm labor contractor after a license has been suspended, revoked, or denied carries a fine of at least $10,000, imprisonment of six months to one year, or both. Confirm with each supervisor that the attestation is accurate before including the form in the package.
A Note on Training Records
Form 403 is a disclosure, not a training record. California also requires farm labor contractors to provide sexual harassment prevention training — at least two hours per calendar year for supervisors, and training at hire and every two years for non-supervisory agricultural employees, delivered in a language the employee understands. DLSE issues a separate form for individual training sessions, and the renewal package must include a list of training materials used and the total number of agricultural employees trained in the previous calendar year.5California Legislative Information. California Code, Labor Code – LAB 1684 Signing Form 403 does not satisfy the training obligation, and completing training does not replace Form 403.