Complaint Form

Please complete the following form to submit a complaint regarding the classification of workers or any issue of non-compliance.

You are not required to provide your name or contact information to report a complaint.

Pursuant to public records law, any information which is provided on this complaint form is disclosable and may be provided (upon request) to the person against whom your complaint is filed.

Please be advised that if the information we receive from you is not sufficient to effectively investigate this matter or there are any questions regarding your complaint and we are unable to contact you, we may be unable to establish a violation of law, and no further action may be taken.

If you would like to file a complaint with a specific agency, feel free to contact that agency directly.

Your Name First Last
Your Phone Number - ### - ### ####
Your Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Email Address
Non-Compliant Entity

Who are you complaining about?
Their Phone Number - ### - ### ####
Their Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Type of Business
Number of Employees
Contact Info for Employees
Contact Info for Witnesses
Nature of Complaint (Please be Specific)