MINIMUM WAGE COMPLAINT FORM



To submit this form electronically, complete form and click "Submit" at bottom of the form.

To mail, print and complete this form and send to:
Division of Labor Standards
Attn: Minimum Wage Program
P.O. Box 449, Jefferson City, MO 65102-0449
Phone: 573-751-3403   Fax: 573-751-3721
E-mail: minimumwage@labor.mo.gov
www.labor.mo.gov/DLS/minimumwage
Minimum Wage Complaint Form
Please Provide e-mail address for confirmation and corespondence about this complaint.

*Type of Complaint (Please check all appropriate boxes.)
By signing the verification below, I waive my right of confidentiality pursuant to Section 290.520 and authorize the Division of Labor Standards to use my name during the investigation of my complaint.

Pursuant to RSMo. 290.527 MODLS can only pursue administrative action for two (2) year from end of employment.

Supporting Documentation
If you are unable to attach the documentation electronically, please indicate below in the "Summary of Complaint" a brief description of documentation you have. An investigator may contact you and ask to have it mailed or faxed to our agency if the documentation is needed.

Please provide a brief description of your job duties and explain why you feel you have not been appropriately paid under the Missouri Minimum Wage Law.