EMPLOYMENT COMPLAINT FORM

Kentucky Labor Cabinet
Division of Employment Standards
1047 U.S. 127 S. STE 4
Frankfort, KY 40601-4381
Telephone: 502-564-3534 ~ Fax: 502-696-1897
www.labor.ky.gov
Personal Information
* Indicates mandatory field
First Name: *
Last Name: *
SSN: *
Home Address: *
- City: *
- State: *
- Zip: *
Email Address:
How were you paid while employed?
     
Pay Rate: *  
Amount Owed:  
Daytime Phone: (8AM - 4:30PM)  
Optional Phone:  
Period of Employment:
- From Date: *  
- To Date:  
Job Title and briefly
describe your Job Duties: 
(50 words max)
*
Nature of Complaint: 
(150 words max)
*
Employer Information
Employer Name:  *
Employer Phone: *
Contact Person:
Contact Title:
Kentucky Address: *
- City: *
- County: *
- Zip:
Out of State Home Office Address (if applicable):
- Address:
- City:
- State:
- Zip:
Submit Complaint
By submitting this complaint form, you are certifying the above information is complete and accurate. Additionally, you are stating this is your valid signature authorizing the Kentucky Labor Cabinet to use your name in the investigation of your referenced employer.
  
  
          Exit and file a paper complaint

Office of Workplace Standards