Division of Labor Standards Harriman State Office Campus Building 12, Room 266B Albany, NY 12240Office Use Only: LS ID LCM PV Priority Taken by Datewww.labor.ny.govLabor Standards Complaint Form Use.
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How to fill out the Labor Standards Complaint Form online
Filing a Labor Standards Complaint is essential for people seeking resolution for unpaid wages or labor law violations. This guide provides clear and supportive instructions to help you fill out the form accurately and effectively.
Follow the steps to complete the Labor Standards Complaint Form online.
- Click 'Get Form' button to obtain the form and open it for completion.
- In Part 1, provide your personal information. Fill in your name, any other names used at work, mailing address, phone numbers, and preferred language. Ensure accuracy as this data helps in processing your complaint.
- In Part 2, provide information on the business or business owner you are filing against. Include the business name, legal name, type of entity, mailing address, business phone number, and owner details.
- In Part 3, detail your employment information. Enter your job title, type of work performed, date hired, and the name of the person who paid your wages. Include the worksite address and specify your employment status.
- Proceed to Part 4 if you are owed unpaid wages. Provide each week’s payroll details, including ending dates, the number of days worked, hours worked, and gross wages owed. Attach additional sheets if necessary.
- In Part 5, complete the section for unpaid paid sick leave if applicable. Fill in the time period, amount of sick leave accrued, dates used, and any benefits owed.
- If you have wage supplements due, fill out Part 6. Describe the promises made regarding benefits, including type, time period, and amounts owed.
- In Part 7, if applicable, fill out details regarding minimum wage or overtime claims. Answer questions related to payment received, hours worked, and any additional pay owed.
- For non-wage complaints, check the relevant issues in Part 8, and explain any further details if necessary.
- In Part 9, provide background on your claim. Include details about any previous inquiries made for wages.
- If applicable, complete Part 10 regarding any retaliatory actions taken by your employer after your complaint.
- In Part 11, indicate if you have representation for this claim and provide relevant details.
- Finally, certify the information provided by signing and dating the form. Ensure all sections are filled out to the best of your knowledge.
- After completing the form, save your changes, download or print it, and return the completed form to the specified address.
Complete your Labor Standards Complaint Form online today to ensure your rights are protected.
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