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劳动部关于印发《劳动争议仲裁委员会仲裁文书样本》的通知

状态:有效 发布日期:1994-06-30 生效日期: 1994-06-30
发布部门: 劳动和社会保障部(原劳动部)
发布文号:
各省、自治区、直辖市劳动争议仲裁委员会、劳动(劳动人事)厅(局): 
  为了规范劳动争议仲裁工作,提高办案质量和效率,我部依据《中华人民共和国劳动争议处理条例》和《劳动争议仲裁委员会办案规则》,在总结各地实践经验的基础上,制定了《劳动争议仲裁委员会仲裁文书样本》。现印发给你们,供在劳动争议仲裁工作中参考使用。 
 
 
《劳动争议仲裁委员会仲裁文书样本》前言 
 
  《中华人民共和国企业劳动争议处理条例》(以下简称《条例》)已由国务院发布实施。这标志着我国的劳动争议仲裁制度已进入新的发展时期。为了贯彻落实《条例》,适应新时期劳动争议仲裁委员会规范办案的需要,我们在总结、吸取各地做法的基础上,借鉴最高人民法院编辑的《法院诉讼文书样式》,组织有实践经验的同志制作了这套34种仲裁文书样本,并分别编写了使用说明①。现就编写的有关事项说明如下: ①原文件各个仲裁文书样本的说明是附在该样本之后的,本书统一把它们调整到 34个仲裁文书之后。 
  一、编写的指导思想是力求使这套仲裁文书样本完整、简明、实用,以推动各地仲裁委员会办案规范化,更好地为保护企业和职工双方的合法权益,促进经济发展和社会稳定服务。在编写过程中,我们遵循:主要的仲裁文书不漏制,可单制也可合制的仲裁文书则合制,可制也可不制的仲裁文书则不制的原则,紧紧扣住《条例》的要求和实践的需要,努力增强其可操作性。 
  二、“仲裁文书样本说明”的内容,主要是从三个方面编写的,即:该文书样本制作的依据,该文书的用途,以及怎样应用该文书等。 
  三、本书仲裁文书样本的顺序,基本是相应于仲裁的申诉、受理、审理准备、审理、结案等程序排列的,以便实际工作人员查阅。 
  四、本仲裁文书样本分填充式和拟制式两种。各地可根据各自的实际工作需要,灵活运用,但应注意不要将两类文书混淆,不能都当作填充式的文书去使用,以免影响仲裁文书的质量和严肃性。 
  五、仲裁文书中凡用“×××”表示的地方,均是请各地在印制实用文书时,根据实际需要填写、印制具体内容的地方。凡是编号中的〔 〕,都是用以填写制作文书当年的年号的。例如〔1999〕、〔2000〕。 
  六、仲裁文书中凡有编号“×劳仲案字〔 〕第 号”的,均应编同一个号码;凡是设有“案号”栏目的仲裁文书,该栏目统一填写该案件仲裁文书的编号:“×劳仲案字〔 〕第 号”。这样做主要是为了便于掌握、运用同一案件中的各种仲裁文书。 
 
 
编者 
1994年6月10日 
 
  (仲裁文书样本之一) 
 
 
劳动争议仲裁申诉登记表 
 
 
  -------------------------------------- 
----- 
  |      时间      |              年    月    日    午    时                
         | 
  |--------|---------------------------- 
----| 
  |  申  |  姓名  |                      |  性别  |        |  民族  |  
         | 
  |      |----|-----------|----|----|----|- 
----| 
  |  诉  |  单位  |                      |  职务  |        |  年龄  |  
         | 
  |      |----|----------------|----|------ 
----| 
  |      |  住址  |                                |        |            
         | 
  |  人  |        |                                |  电话  |            
         | 
  |      |或地址  |                                |        |            
         | 
  |--------|---------------------------- 
----| 
  |    被诉人      |                                                        
         | 
  |------------------------------------- 
----| 
  |    申    |                                                              
         | 
  |    诉    |                                                              
         | 
  |    内    |                                                              
         | 
  |    容    |                                                              
         | 
  |-----|------------------------------- 
----| 
  |    承    |                                                              
         | 
  |    办    |                                                              
         | 
  |    人    |                                                              
         | 
  |    处    |                                                              
         | 
  |    理    |                                                              
         | 
  |    意    |                                                              
         | 
  |    见    |                                                              
         | 
  |-----|------------------------------- 
----| 
  |    备    |                                                              
         | 
  |    注    |                                                              
         | 
  -------------------------------------- 
-----   
 
 
 
  (仲裁文书样本之二) 
 
 
劳动争议仲裁申诉书 
 
 
  -------------------------------------- 
---------- 
  |                申    诉    人                ||              被    诉  
   人              | 
  |-----------------------||------------ 
---------| 
  |    姓  名    |                              ||  姓  名    |          
                   | 
  |  或单位名称  |                              ||或单位名称  |          
                   | 
  |-----------------------||------------ 
---------| 
  |  单位性质  |                                ||  单位性质  |          
                   | 
  |------|----------------||------|----- 
---------| 
  |  法定代表人|        |          |          ||  法定代表人|        | 
          |      | 
  |            |        |  职  务  |          ||            |        | 
  职  务  |      | 
  |    姓  名  |        |          |          ||    姓  名  |        | 
          |      | 
  |------|----|-----|-----||------|----| 
-----|---| 
  |    性  别  |        |  年  龄  |          ||    性  别  |        | 
  年  龄  |      | 
  |------|----|-----|-----||------|----| 
-----|---| 
  |            |        |  用  工  |          ||            |        | 
  用  工  |      | 
  |  民族或国籍|        |          |          ||  民族或国籍|        | 
          |      | 
  |            |        |  性  质  |          ||            |        | 
  性  质  |      | 
  |------|----------------||------|----- 
---------| 
  |  工作单位  |                                ||  工作单位  |          
                   | 
  |------|----------------||------|----- 
---------| 
  |  地    址  |                                ||  地    址  |          
                   | 
  |------|----------------||------|----- 
---------| 
  |  电    话  |                                ||  电    话  |          
                   | 
  |------|----------------||------|----- 
---------| 
  |  邮    编  |                                ||  邮    编  |          
                   | 
  -------------------------------------- 
----------   
   
  请求事项: 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  事实和理由(包括证据和证据来源,证人姓名和住址等情况): 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
  -------------------------------------- 
---------- 
                                            此    致 
                                                              ×××劳动争议仲 
裁委员会 
                                                        申诉人:_______ 
_(签名或盖章) 
                                                                            年 
    月    日   
 
 
 
  附: 
  1.副本___________份; 
  2.物证___________件; 
  3.书证___________件。 
  注: 
  1.申诉书应用钢笔、毛笔书写或印制。 
  2.请求事项应简明扼要地写明具体要求。 
  3.事实和理由部分空格不够用时,可用同样大小纸续加中页。 
  4.申诉书副本份数,应按被诉人数提交。 
  (仲裁文书样本之三) 
 
 
×××劳动争议仲裁委员会 
 
 
立案审批表 
 
 
×劳仲审字〔 〕第 号 
 
 
  -------------------------------------- 
- 
  |  申诉人  |                                                              
 | 
  |-----|------------------------------- 
| 
  |  被诉人  |                                                              
 | 
  |-----|------------------------------- 
| 
  |          |                                                              
 | 
  |          |                                                              
 | 
  |          |                                                              
 | 
  |    案    |                                                              
 | 
  |          |                                                              
 | 
  |    情    |                                                              
 | 
  |          |                                                              
 | 
  |    摘    |                                                              
 | 
  |          |                                                              
 | 
  |    要    |                                                              
 | 
  |          |                                                              
 | 
  |          |                                                              
 | 
  |          |                                                              
 | 
  |-----|------------------------------- 
| 
  |          |                                                              
 | 
  |  承办人  |                                                              
 | 
  |  意  见  |                                                              
 | 
  |          |            承办人:                    年    月    日        
 | 
  |-----|------------------------------- 
| 
  |          |                                                              
 | 
  |  审  批  |                                                              
 | 
  |  意  见  |                                                              
 | 
  |          |            负责人:                    年    月    日        
 | 
  |-----|------------------------------- 
| 
  |          |                                                              
 | 
  |  备  注  |                                                              
 | 
  |          |                                                              
 | 
  -------------------------------------- 
-   
 
 
 
  (仲裁文书样本之四) 
 
 
×××劳动争议仲裁委员会 
 
 
受理案件通知书 
 
 
×劳仲案字〔 〕第 号 
 
  : 
  年 月 日送来的申诉书已收悉。根据《中华 人民共和国企业劳动争议处理条例》的规定,经本委审查,申诉书 中所提及的劳动争议符合受理条件,本委决定受理。现将有关事项通知如下: 
  一、请你(单位)在送达回执上签收本通知。 
  二、请填写法定代表人(或主要负责人)身份证明书,如委托代理人的请填写授权委托书,于 年 月 日前提交本委。 
  三、按照规定,请在接到本通知书 日内向本委交纳受理费 元,预交处理费 元。 
  四、请向本委补充提供下列证明材料。 
 
 
×××劳动争议仲裁委员会 
年 月 日 
 
  附:法定代表人(或主要负责人)身份证明书一份,授权委托书一份。 
  (仲裁文书样本之五) 
 
 
×××劳动争议仲裁委员会 
 
 
不予受理案件通知书(存根) 
 
 
×劳仲不字〔 〕第 号 
 
  : 
  年 月 日送来的申诉书已收悉。经审查,不符合受理条件,本委决定不予受理。主要理由如下: 
 
  特此通知 
 
 
×××劳动争议仲裁委员会 
年 月 日 
 
 
×××劳动争议仲裁委员会 
 
 
不予受理案件通知书 
 
 
×劳仲不字〔 〕第 号 
 
  : 
  年 月 日送来的申诉书已收悉。经审查,不符合受理条件,本委决定不予受理。主要理由如下: 
  特此通知 
 
 
×××劳动争议仲裁委员会 
年 月 日 
 
  (仲裁文书样本之六) 
 
 
×××劳动争议仲裁委员会 
 
 
应诉通知书 
 
 
×劳仲案字〔 〕第 号 
 
  ____________: 
  本委决定受理 与你(单位)的劳动争议一案( ),现依照《中华人民共和国企业劳动争议处理条例》的规定,将有关事项通知如下: 
  一、请在本通知的送达回执上签收。 
  二、在收到申诉书副本十五日内,向本委提交答辩书和有关证据,不按时提交答辩书或不提交答辩书,不影响案件的处理。 
  三、被诉人系企业的,需填写法定代表人(或主要负责人)身份证明书;如委托代理人的需填写授权委托书,于 年 月 日前提交本委。 
  四、按规定,请在接到本通知书 日内向劳动争议仲裁委员会预缴处理费 元。 
 
 
×××劳动争议仲裁委员会 
年 月 日 
 
  附:申诉人的申诉书副本一份,法定代表人(或主要负责人)身份证明书一份,授权委托书一份。 
 
  (仲裁文书样本之七) 
 
 
×××劳动争议仲裁委员会 
 
 
仲裁庭组成人员审批表 
 
 
  ------------------------------------- 
  |          |                                                          | 
  |  案  号  |                                                          | 
  |          |                                                          | 
  |-----|-----------------------------| 
  |          |                                                          | 
  |  案  由  |                                                          | 
  |          |                                                          | 
  |-----|-----------------------------| 
  |          |                                                          | 
  |          |申诉人:                                                  | 
  |          |                                                          | 
  |  当事人  |-----------------------------| 
  |          |                                                          | 
  |          |被诉人:                                                  | 
  |          |                                                          | 
  |-----|-----------------------------| 
  |          |                                                          | 
  | 受理日期 |                                                          | 
  |          |                                                          | 
  |-----|-----------------------------| 
  |          |            |                                            | 
  |          |  独任审理  |仲裁员:                书记员:            | 
  |          |            |                                            | 
  |    仲    |------|----------------------| 
  |    裁    |            |首席仲裁员:            书记员:            | 
  |    庭    |  合议审理  |                                            | 
  |    组    |            |仲裁员:                                    | 
  |    成    |------|----------------------| 
  |    人    |  特别合议  |首席仲裁员:            书记员:            | 
  |    员    |            |                                            | 
  |          |            |                                            | 
  |          |  审    理  |仲裁员:                                    | 
  |-----|-----------------------------| 
  |          |                                                          | 
  |          |                                                          | 
  |          |                                                          | 
  |    审    |                                                          | 
  |    批    |                                                          | 
  |    意    |                                                          | 
  |    见    |                                                          | 
  |          |                                                          | 
  |          |                                                          | 
  |          |                                    年    月    日        | 
  |-----|-----------------------------| 
  |          |                                                          | 
  |  备  注  |                                                          | 
  |          |                                                          | 
  -------------------------------------  
 
 
 
  (仲裁文书样本之八) 
 
 
法定代表人(或主要负责人)身份证明书 
 
  同志现任我单位 职务,为法定代表人(或主要负责人),特此证明。 
 
  附: 
  法定代表人(或主要负责人): 
  性别: 
  年龄: 
  民族: 
  住址: 
  联系电话: 
  邮政编码: 
 
 
×××(单位全称,加盖印章) 
年 月 日 
 
  (仲裁文书样本之九) 
 
 
授 权 委 托 书 
 
  _______劳动争议仲裁委员会: 
  你委受理__________一案,依照法律规定,特委托下列人员为我方代理人: 
  1.姓名_____性别_____年龄_____工作单位____________职务_______住址______________联系电话______邮政编码______ 
  2.姓名_____性别_____年龄_____工作单位____________职务_______住址______________联系电话______邮政编码______ 
  委托事项和权限如下: 
 
 
委托人: (签名或盖章) 
受委托人: (签名或盖章) 
年 月 日 
 
  注:本委托书一式三份,一份在接到受理通知书或应诉通知书后向劳动争议仲裁委员会提交,一份委托人留底,一份交受委托人。 
 
  (仲裁文书样本之十) 
 
 
×××劳动争议仲裁委员会 
 
 
指定代理人通知书 
 
 
×劳仲案字〔 〕第 号 
 
  ___________: 
  根据《中华人民共和国企业劳动争议处理条例》第 二十条的规定,本委指定你(单位)为_________劳动争议案的________方代理人。请你(单位)于____年__月_____日前来本委办理有关事项。本委办公室地址: 
  特此通知 
 
 
×××劳动争议仲裁委员会 
年 月 日 
 
  (仲裁文书样本之十一) 
 
 
劳动争议仲裁委员会 
 
 
仲裁第三人通知书 
 
 
×劳仲案字〔 〕第 号 
 
  ___________: 
  根据《中华人民共和国企业劳动争议处理条例》第 二十二条的规定,本委决定你(单位)应为_______劳动争议案的第三人参加仲裁活动。请你(单位)于____年__月__日前来本委办理有关事项。本委办公室地址: 
  特此通知 
 
 
劳动争议仲裁委员会 
年 月 日 
 
  (仲裁文书样本之十二) 
 
 
×××劳动争议仲裁委员会 
 
 
回避申请书 
 
 
  ------------------------------------ 
  |            |                    |              |                | 
  |  案    号  |                    |    申请人    |                | 
  |            |                    |              |                | 
  |------|----------|-------|--------| 
  |            |                    |              |                | 
  |    回避人  |                    |    回避方式  |                | 
  |            |                    |              |                | 
  |------|---------------------------| 
  |            |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |      申    |                                                      | 
  |      请    |                                                      | 
  |      回    |                                                      | 
  |      避    |                                                      | 
  |      理    |                                                      | 
  |      由    |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  申请时间  |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |      审    |                                                      | 
  |      批    |                                                      | 
  |      意    |                                                      | 
  |      见    |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |            |                                        年    月    日| 
  ------------------------------------   
 
 
 
  注: 
  1.回避方式有二种:一种为自行回避,即由审理案件的仲裁人员提出;另一种为申请回避,即由争议双方当事人提出。 
  2.对回避申请应在七日内作出准予或不准予回避的决定。 
  3.对回避的决定,仲裁委员会主任由仲裁委员会决定,仲裁委员会其他成员、仲裁员和其他人员由仲裁委员会主任决定。 
 
  (仲裁文书样本之十三) 
 
 
×××劳动争议仲裁委员会 
 
 
调 查 提 纲 
 
 
  ------------------------------------- 
  |  案    号  |                        |  立案时间  |                | 
  |------|----------------------------| 
  |  案    由  |                                                        | 
  |------|----------------------------| 
  |  申诉人    |                                                        | 
  |------|----------------------------| 
  |  被诉人    |                                                        | 
  |------|----------------------------| 
  |  调查人    |                                                        | 
  |------|----------------------------| 
  |  被调查人  |                                                        | 
  |------|----------------------------| 
  |  预期完成  |                                                        | 
  |  时    间  |                                                        | 
  ------------------------------------- 
  需查阅的档案、资料和其他证明材料:____________________ 
  _____________________________________ 
  _____________________________________ 
  _____________________________________ 
  _____________________________________ 
  调查项目和要求:_____________________________ 
  _____________________________________ 
  _____________________________________ 
  _____________________________________ 
  注:本页不够时可接用笔录纸,上下页间加盖骑缝章。   
 
 
 
  (仲裁文书样本之十四) 
 
 
调 查 笔 录 
 
  调查时间:____年____月____日____时____分至____时____分 
  调查地点:_________________________ 
  调查人:__________________________ 
  记录人:__________________________ 
  被调查人姓名:________性别_____年龄____ 
  职务:________工作单位:___________ 
  电话:_______邮编:______ 
  地(住)址:____________ 
  调查情况(问、答或观察情况):___________________________________________________________________________________________________________________________________________________________________________________________________ 
  注: 
  1.本页不够用,可接用笔录纸副页。 
  2.最后页就有调查人、被调查人签名。重要的调查笔录、被调查人要在每一页签名。 
  3.上下之间应加盖骑缝章。 
 
  (仲裁文书样本之十五) 
 
 
×××劳动争议仲裁委员会 
 
 
委 托 调 查 函(存根) 
 
 
                                            ×劳仲调字〔        〕第        号 
  _________劳动争议仲裁委员会: 
      我委受理___________案件(案号:×劳仲案字〔        〕 
  第        号),根据《中华人民共和国企业劳动争议处理条例》第三 
  十三条规定,请你委协助调查,并在____月____日前将调查 
  结果函告我委。如不能按期完成调查,请在______月____ 
  日前函告我委。 
      调查事项: 
      签发人: 
      经办人: 
                                      ×××劳动争议仲裁委员会 
                                                年    月    日   
 
 
 
 
×××劳动争议仲裁委员会 
 
 
委 托 调 查 函 
 
 
                                           ×劳仲调字〔        〕第        号 
  __________劳动争议仲裁委员会: 
      我委受理____________案件(案号:×劳仲案字〔        〕 
  第        号),根据《中华人民共和国企业劳动争议处理条例》第三 
  十三条规定,请你委协助调查,并在____月____日前将调查 
  结果函告我委。如不能按期完成调查,请在______月____ 
  日前函告我委。 
      调查事项: 
                                      ×××劳动争议仲裁委员会 
                                                年    月    日   
 
 
 
  (仲裁文书样本之十六) 
 
 
×××劳动争议仲裁委员会 
 
 
委托勘验或鉴定函(存根) 
 
  委托单位:_____________ 
  案 号:_____________ 
  申诉人:______________ 
  被诉人:______________ 
  回复日期:______年____月____日前 
  勘验 
  内容: 
  鉴定 
  签发人: ____年__月__日 
  经办人: ____年__月__日 
 
 
×××劳动争议仲裁委员会 
年 月 日 
 
 
×××劳动争议仲裁委员会 
 
 
委托勘验或鉴定函 
 
 
                                         ×劳仲勘鉴字〔        〕第        
 号 
  ___________: 
      本委受理的_____________________诉__ 
  ____________________劳动争议一案,因___ 
  ___________特委托你单位协助勘验、鉴定(提纲另附)。 
  请将勘验、鉴定结果于____年__月__日前回复本委。如 
  不能按期回复,请于____年__月__日前函告本委。 
                                      ×××劳动争议仲裁委员会 
                                                年    月    日 
                                                  (印    章)   
 
 
 
  (仲裁文书样本之十七) 
 
 
×××劳动争议仲裁委员会 
 
 
通 知(存根) 
 
 
×劳仲通字〔 〕第 号 
 
 
  ------------------------------------ 
  |            |                                                      | 
  |  案    号  |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  被通知人  |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |  所    在  |                                                      | 
  |            |                                                      | 
  |  单位名称  |                                                      | 
  |------|---------------------------| 
  |  通知事由  |                                                      | 
  |    和事项  |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  应到时间  |                        年    月    日    午    时    | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  应到场所  |                                                      | 
  |            |                                                      | 
  |----------------------------------| 
  |                                    |                              | 
  |签发人:                            |签发时间:                    | 
  |                                    |                              | 
  |------------------|---------------| 
  |                                    |                              | 
  |送达人:                            |送达方式:                    | 
  |                                    |                              | 
  |----------------------------------| 
  |                                                                    | 
  |备注:                                                              | 
  |                                                                    | 
  |                                                                    | 
  |                                                                    | 
  |                                                                    | 
  |                                                                    | 
  ------------------------------------   
 
 
 
 
×××劳动争议仲裁委员会 
 
 
通 知 
 
 
                                            ×劳仲通字〔        〕第        号 
  ------------------------------------ 
  |            |                                                      | 
  |  案    号  |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  被通知人  |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |所在单位名称|                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |    通      |                                                      | 
  |    知      |                                                      | 
  |    事      |                                                      | 
  |    由      |                                                      | 
  |    和      |                                                      | 
  |    事      |                                                      | 
  |    项      |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  应到时间  |            年    月    日    午    时                | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  应到场所  |                                                      | 
  |            |                                                      | 
  |------|---------------------------| 
  |            |                                                      | 
  |  发送时间  |            年    月    日    (印  章)              | 
  |            |                                                      | 
  ------------------------------------   
 
 
 
 
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