Employment Standards Complaint Form

Employer Information
Employee Information
Authorization
Employment Details
What Do You Believe You Are Owed?
Complaint Details

Employer Information

Business Name

Mailing Address

City

Province

State

Country

Postal/Zip Code

Different Work Location

Contact Person

Telephone

Is your employer still in business? Yes No

Is your employer bankrupt or in receivership? Yes No

Type of Business

Name and location of the bank or credit union the employer uses

Employee Information

Last Name

First Name

Mailing Address

City

Province

State

Country

Postal/Zip Code

Phone Number

Are you covered by a collective agreement? Yes No

Did You Know?

Employees who are covered by a collective agreement cannot file a complaint with Employment Standards. Contact your union representative to find out the proper way to resolve workplace disputes.

Authorization

If you authorize anyone to act on your behalf, please provide:

Name

Phone Number

I authorize the above mentioned party to obtain, share, release and discuss personal information related to my Employment Standards claim.

If you will be using an interpreter, please provide:

Name

Phone Number

Complaint Details

Please keep this section to a maximum of 4000 characters (approximately 800 words)

Important

Please print a copy of this form for your records before clicking submit.

Employer Information

Employee Information

Did You Know?

Authorization

Employment Details

Type of Wage owed

Complaint Details

Important