Payment Compliance Complaint Form
THE INDUSTRIAL COMMISSION OF ARIZONA
LABOR DEPARTMENT
Payment Compliance Complaint Form
* indicates required field

EMPLOYER INFORMATION: Identify the employer involved in the Payment Compliance violation.

Payment Compliance COMPLAINT: If your complaint is not for one of the 3 selections below, please contact the Labor Department at (602) 542-4515 for further assistance.
If you have not been paid and are owed wages, DO NOT complete this form. Complete the Wage Claim form by clicking on the link below. https://www.azica.gov/forms/labor3303

COMPLAINANT INFORMATION

Sign and Date Section
7/8/2020 ]





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