PREVAILING WAGE COMPLAINT FORM

For Workers on Public Works Projects
Sections 290.210-290.340, RSMo
Section 292.675, RSMo 10 Hour Construction Safety Training
Sections 290.550-290.580 Excessive Unemployment

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: Prevailing Wage Program
P.O. Box 449, Jefferson City, MO 65102-0449
Phone: 573-751-3403   Fax: 573-751-3721
E-mail: prevailingwage@labor.mo.gov
www.labor.mo.gov/DLS/prevailingwage
Complainant                
         
  
 
  
        
  ( -   ( -
  
  
* Please Provide e-mail address for confirmation and corespondence about this complaint.
Type of Complaint - Required
  
  
   (please identify fringes below)
      
                
             
  
  
  
  
  
PROJECT IDENTIFICATION - Complaint Against
  
  
  
     
  ( -   ( -
           
Are you currently employed by this contractor?   NO YES
       
               /        /
Type of project:                     
  
    
       
  
Is project completed?   YES NO
   / /
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.
SUMMARY OF COMPLAINT (Required)
  First Name Last Name  
By entering my name and submitting this electronically,
I do hereby affirm under penalties of perjury that the above-stated information is true and correct to the
best of my knowledge, information, and belief.