Wage Theft Inquiry Form

SUBMITTING THIS FORM DOES NOT MEAN THAT A COMPLAINT HAS BEEN FILED WITH OUR OFFICE. YOU WILL BE CONTACTED WITHIN 2 BUSINESS DAYS AFTER WE RECEIVE YOUR INQUIRY FORM. FOR IMMEDIATE ASSISTANCE, PLEASE CONTACT THE ALACHUA COUNTY EQUAL OPPORTUNITY OFFICE AT 352-374-5275.

*First Name This field is required.

*Last Name This field is required.

Address This field is required

Home Phone Number This field is required.

Cell Phone Number This field is required.

eMail Address This field is required.

Other Contact Method This field is required.

Best Time to Contact This field is required.

Best Way to Contact

Home Phone Cell Phone eMail Other

Referred By This field is required.

Inquiry on Behalf of Another?

Yes No

Employer This field is required.

Work Performed in Alachua County? Required

Yes

No

This field is required

Date Wages Were Due

Date Wages Were Due Date

Has This Been Discussed?

Yes, and I have documentation Yes, but I do not have documentation No

Can You Bring Records?

Yes No

Were You Paid in Cash?

I was paid in cash and have documentation I was paid in cash, but do not have documentation I was not paid in cash