Document Number: LS-119-E
Description: This form is used to file a complaint on the following: Overtime, Child Labor, Unpaid Hours of Work, One Day of Rest in Seven, Medical Exams, Minimum Wage, Street Trades, Deduction from Wages, Personnel Records, Seats for Workers, Severance Pay, Commissions, Bonus Pay or Vacation/Holiday/Sick Pay.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). If you do not have Microsoft Word, you should use the LS-119 print version or the LS-119-S Spanish print version that is not fill enabled, and should be printed and completed by hand.
Content Contact: Equal Rights Information
LS-119-E (Electronic Version - Word/72 KB)
LS-119 (English Print Version - pdf/73 KB)
LS-119-S (Spanish Print Version - pdf/230 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.