Amador — WV-109

Source: https://amador.courts.ca.gov/system/files/forms-and-filings/wv109.pdf

WV-109 Notice of Court Hearing Clerk stamps date here when form is filed. To keep other people from seeing what you entered on 1 Petitioner (Employer) your form, please press the a. Name: Clear This Form button at the Lawyer for Petitioner (if any for this case): end of the form when finished. Name: State Bar No.: Firm Name:

b. Address (If you have a lawyer, give your lawyer’s information.):

Fill in court name and street address:
Address: Superior Court of California, County of
City: State: Zip:
Telephone: Fax:
E-Mail Address:

2 Employee in Need of Protection Fill in case number: Full Name: Case Number:

3 Respondent (Person From Whom Protection Is Sought)

Full Name:

The court will complete the rest of this form.

4 Notice of Hearing

A court hearing is scheduled on the request for restraining orders against the respondent:

Name and address of court if different from above:

Hearing Date: Time:
Date
Dept.: Room:

5 Temporary Restraining Orders (Any orders granted are on Form WV-110, served with this notice.) a. Temporary Restraining Orders for personal conduct and stay away orders as requested in Form WV-100, Request for Workplace Violence Restraining Orders, are (check only one box below): (1) All GRANTED until the court hearing.

(2) All DENIED until the court hearing. (Specify reasons for denial in b, below.)

(3) Partly GRANTED and partly DENIED until the court hearing. (Specify reasons for denial in
b, below.)

Judicial Council of California, www.courts.ca.gov Revised January 1, 2012, Mandatory Form Notice of Court Hearing WV-109, Page 1 of 3 Code of Civil Procedure, § 527.8 (Workplace Violence Prevention) Approved by DOJ

Case Number:

b. Reasons that Temporary Restraining Orders as requested in Form WV-100, Petition for Workplace
Violence Restraining Orders, for personal conduct or stay away are denied are:

(1) The facts as stated in Form WV-100 do not sufficiently show reasonable proof that the employee
has suffered unlawful violence or a credible threat of violence by the respondent, and that great or
irreparable harm to the employee would result if a temporary restraining order is not issued.

(2) Other (specify): As stated on Attachment 5b.

6 Service of Documents by the Petitioner

At least five days before the hearing, someone age 18 or older—not you or anyone to be
protected—must personally give (serve) a court file-stamped copy of this Form WV-109, Notice of Court Hearing,
to the respondent along with a copy of all the forms indicated below:

a. WV-100, Petition for Workplace Violence Restraining Orders (file-stamped)
b. WV-110, Temporary Restraining Order (file-stamped) IF GRANTED
c. WV-120, Response to Petition for Workplace Violence Restraining Orders (blank form)
d. WV-120-INFO, How Can I Respond to a Petition for Workplace Violence Restraining Orders?.
e. WV-250, Proof of Service of Response by Mail (blank form)
f. Other (specify):

Date:
Judicial Officer

To the Petitioner:

• The court cannot make the restraining orders after the court hearing unless the respondent has been personally
given (served) a copy of your request and any temporary orders. To show that the respondent has been served,
the person who served the forms must fill out a proof of service form. Form WV-200, Proof of Personal
Service, may be used.

• For information about service, read Form WV-200-INFO, What Is “Proof of Personal Service”?
• If you are unable to serve the respondent in time, you may ask for more time to serve the documents. Use
Form WV-115, Request to Continue Court Hearing and to Reissue Temporary Restraining Order.

Revised January 1, 2012 Notice of Court Hearing WV-109, Page 2 of 3 (Workplace Violence Prevention)

Case Number:

To the Respondent

• If you want to respond to the request for orders in writing, file Form WV-120, Response to Request for
Workplace Violence Restraining Orders, and have someone age 18 or older—not you or anyone to be
protected—mail it to the petitioner.
• The person who mailed the form must fill out a proof of service form. Form WV-250, Proof of Service of
Response by Mail, may be used. File the completed form with the court before the hearing and bring a copy with
you to the court hearing.
• Whether or not you respond in writing, go to the hearing if you want the judge to hear from you before making
an order. You may tell the judge why you agree or disagree with the orders requested.
• You may bring witnesses and other evidence.

• At the hearing, the judge may make restraining orders against you that could last up to three years and
may order you to sell or turn in any firearms that you own or possess.

Request for Accommodations
Assistive listening systems, computer-assisted real-time captioning, or sign language
interpreter services are available if you ask at least five days before the hearing. Contact the
clerk’s office or go to www.courts.ca.gov/forms for Request for Accommodations by Persons
with Disabilities and Response (Form MC-410). (Civ. Code, § 54.8.)

(Clerk will fill out this part.)

—Clerk’s Certificate—

I certify that this Notice of Court Hearing is a true and correct copy of the original on file in the court.

Clerk’s Certificate
[seal]

Date:

Clerk, by , Deputy

Revised January 1, 2012 Notice of Court Hearing WV-109, Page 3 of 3 (Workplace Violence Prevention)

For your protection and privacy, please press the Clear This Form button after you have printed the form. Save This Form Print This Form Clear This Form