Follow the steps to complete the AK Overtime Limitations Nurse Complaint Form online

1. Click ‘Get Form’ button to access the AK Overtime Limitations Nurse Complaint Form in an editable format.
2. Enter the date of your complaint in the designated field at the top of the form.
3. Fill in your name in the 'Claimant Name' field, ensuring that it matches your legal name.
4. Provide your complete address, including city, state, and zip code, in the 'Address' section.
5. Input your contact information in the phone, cell, and email fields to allow for communication regarding your complaint.
6. Identify the health care facility you are associated with by entering its name and address.
7. List the facility's phone and fax numbers for reference.
8. Provide the printed name of your supervisor in the appropriate section.
9. Indicate the date of the alleged violation by filling in the corresponding field.
10. Respond to the questions regarding whether you were asked or directed to work past your scheduled shift by selecting the appropriate option.
11. Indicate if you agreed to work past your scheduled shift by selecting 'yes' or 'no'.
12. Fill in details about whether you did indeed work past your scheduled shift.
13. Write down the name and title of the individual who directed you to work extra hours, along with their contact information.
14. Specify if a union represents you and, if applicable, provide the union's name, address, and phone number.
15. Describe the circumstances leading to the request for overtime work in the provided text box, using clear and concise language.
16. Detail your scheduled shift on the violation date, including the 'From' and 'To' times.
17. List your regular scheduled shift for each day of the week.
18. If applicable, list the names and phone numbers of any witnesses who can corroborate your claims.
19. Confirm that the information you provided is true by signing and printing your name at the bottom of the form.
20. Save your changes, and then download or print the completed form for submission.

Take action and fill out your complaint form online today to ensure your rights are protected.