Employment Status

Which best describes you:

Contact Information

Name of Complaintant
Telephone Number(s)
more items

Contact Address

Mailing Address Information

Job Information

Re-order Final Wage Period Weight Operations

Representative Information

Representative Name

Union Information

Are you represented by a union?
Basic Union Information
Union Steward
Business Agent Name

Union Address Information

Union Address

Employer Information

Supervisor Name

Employer Address Information

Worksite Address
Mailing Address

Allegation Information

Type of Retaliation

Reasons for Action Taken

Have you filed a previous complaint or complaints against the employer?
The organization you filed a complaint with.

Other Actions

Have you taken any other actions to appeal, file a grievance or report this?
Name, Agency, etc.



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