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Employee Payroll Report Template

Legislation signed into law in 2011 amended California Labor Code §226. (Click here to view LC §226) The law now requires farm labor contractors (FLC) to disclose to each employee in an itemized wage statement (paycheck stub) the name and address of farmers or ranchers securing the contractor's services.

The state Labor Commissioner has developed a sample paycheck itemization template which serves as an example of a wage statement. Below is that template.


1. Although it is not required to use this template exactly, an FLC must provide all the information that is contained in the template on the wage statements provided to employees.
2. The sample template calls for the employee's social security number, but only the last four digits of an employee's SSN may lawfully be shown on a wage statement.
3. There is no space for piece-rate information, which must be included where applicable.


Sample Template*:

FLC Template
Click here for larger view of template

*Source:  DLSE Farm Labor Contractor License Forms & Instructions DLSE 406 (Rev. 11/11), Page 3 - (doc)

Licencia de Contratista de Trabajadores Agricolas Formularios e Instrucciones (Rev. 11/11) - (doc)