Minimum Wage Intake Form

The City of Petaluma has a local minimum wage that is higher than the State minimum wage. This wage applies to hours worked within the Petaluma city limits. When calculating this wage, employers can include commissions but are not allowed to include tips and/or benefits (such as room/board allowances, medical benefits, etc.).

The chart to the right lists the correct Petaluma minimum wage(s) for 2020 - 2022. If you feel you have been paid incorrectly, please complete the intake form below.

*Note: Some locations with a Petaluma address are not located within the Petaluma city limits. Before submitting the form, please confirm that the hours were worked within the Petaluma city limits.

 

  • Date Format: MM slash DD slash YYYY
  • Your Name * Required
  • Your Address * Required
  • Date Format: MM slash DD slash YYYY
  • Check which box applies
  • Date Format: MM slash DD slash YYYY
  • If no longer working for that employer, have you received your final payment of wages?
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
wage chart
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