Labor Commissioner's Office (LCO )

WARNING:

There was an error processing your complaint or this complaint has already been submitted and can not be submitted again.  If you feel this is an error please contact support at onlineRCIcomplaint@dir.ca.gov.

Case Number :

RETALIATION COMPLAINT

EQUAL PAY ACT (EPA) COMPLAINT

PAY TRANSPARENCY COMPLAINT

RETALIATION COMPLAINT INVESTIGATION UNIT

Retaliation Complaint

Before continuing, please review the information below:
If you are a worker who exercised a right protected by law, and your employer made a negative action against you, you have suffered retaliation and you may file a retaliation complaint.
There are many rights protected by law including, but not limited to, filing or threatening to file a wage claim with the Labor Commissioner’s Office, asking for your unpaid wages, reporting illegal activity, complaining about unsafe or unhealthy conditions in the workplace, or refusing to perform work that may be very dangerous to you.
A negative action may include, but is not limited to, your employer firing you, cutting your hours, threatening to call immigration on you, or other negative consequences.
If you already filed a retaliation complaint because you complained about health or safety in the workplace, you may also file a separate complaint with the Federal OSHA within 30 days of the date of the negative consequence happening.
Please be specific so our office may efficiently review your complaint.
Please include the date you exercised your right protected by law and the date the negative action happened or your best estimate.
Providing all of your contact information allows our office to contact you more easily.

After submitting your complaint, you will receive a confirmation email with your case number.

Equal Pay ACT (EPA)

Before continuing, please review the information below:
An EPA complaint is about being paid less than a person of the opposite sex, of another race, or of another ethnicity who is performing substantially similar work to the work you perform.
Please be accurate so our office may properly review your complaint and include specific dates, pay information, or your best estimate.
If you believe you experienced retaliation from raising this issue with your employer, you must file a separate retaliation complaint in addition to this EPA complaint.
Providing all of your contact information allows our office to contact you more easily.

After submitting your complaint, you will receive a confirmation email with your case number.

Pay Transparency Complaint (PTC)

Before continuing, please review the information below:
Pay Transparency Complaints include reporting job postings without pay scales, salaries, or hourly ranges.
Pay Transparency Complaints also include reporting employers who sought the salary history for applicant’s seeking employment and used that information to offer employment to determine pay rates.
Pay Transparency Complaints are also the reporting of an employer that failed to provide a pay scale to an applicant for employment, or to an employee for their current position when requested.
You must provide all of the required information. Failure to do so will result in incomplete complaints. Please gather all employer information before moving on to the next page.
If you believe you experienced retaliation from raising this issue to the employer, you must file a separate retaliation complaint with RCI in addition to this complaint.
Please have all the necessary information ready to complete the complaint as you cannot save your progress.

After submitting your complaint, you will receive a confirmation email with your case number.

For technical support for this form only, please email onlineRCIcomplaint@dir.ca.gov

Case Id

Case Status

ComplaintType

Complaint Type Text

Complainant Information

RETALIATION COMPLAINT

EQUAL PAY ACT (EPA) COMPLAINT

PAY TRANSPARENCY COMPLAINT

RETALIATION COMPLAINT INVESTIGATION UNIT

Complainant Information

First Name

Middle name

Last Name

Phone Type

Please include area code, XXX-XXX-XXXX

Home Phone

Mobile Phone

Work Phone

Date of Birth (MM/DD/YYYY)

Complainant Address

Do you have a permanent Address?

No Permanent Address

Physical Address

Do not copy and paste. Please spell out North, South, East, West.

Physical City

Physical State

Abbreviate State ex. CA, NY

Physical Zip Code

Mailing Address Same as Physical

Yes

Mailing Address

Do not copy and paste. Please spell out North, South, East, West.

Mailing City

Mailing State

Abbreviate State ex. CA, NY

Mailing Zip Code

Email

If no email is provided, it may delay your request.

Confirm Email

If no email is provided, it may delay your request.

I consent to official communication through email.

Language Assistance

Do you need an interpreter?

Interpreter Language

Other Language

Advocate/Representative assistance

Are you being assisted by a lawyer or other advocate?

Advocate/Representation Information

Advocate/Representation Type

Organization Name

Law Firm Name

Advocate/Attorney Name

First Name

Middle Name

Last Name

Website Address

Email

If no email is provided, it may delay your request.

Confirm Email

If no email is provided, it may delay your request.

Phone Type

Please include area code, XXX-XXX-XXXX

Home Phone

Mobile Phone

Work Phone

Physical Business Address

Do not copy and paste. Please spell out North, South, East, West.

Physical City

Physical State

Abbreviate State ex. CA, NY

Physical Zip Code

Mailing Address Same as Physical

Yes

Mailing Address

Do not copy and paste. Please spell out North, South, East, West.

Mailing City

Mailing State

Mailing Zip Code

Employment Status

Date of Hire (MM/DD/YYYY)

Current Job Title with Employer

Still Working for Employer?

Reason for Leaving

Complete At Least One of the Following

Last Date of Work (MM/DD/YYYY)

If you are no longer working for the employer, what was your final rate of pay?

Provide estimate if unknown.

Pay Frequency

Frequency of pay.

Last Job Title with Employer

Job Duties

Other Claims Filed

Have you filed a claim for unpaid wages against your employer with the Labor Commissioner’s Office?

If you were not paid your wages and would like to learn about filing a wage claim, please visit: https://www.dir.ca.gov/dlse/HowToFileWageClaim.htm

Wage Claim Filed

Date of Wage Claim filed (MM/DD/YYYY)

How did you file your wage claim

Wage Claim Case number

What was the issue claimed?

Retaliation Complaint Filed

If you filed another retaliation complaint against this employer, please enter the information below.

Retaliation complaint Case Number

Date of Retaliation Complaint filed (MM/DD/YYYY)

Other Complaints Filed

Are there any other complaints filed?

Describe the Complaint

For technical support for this form only, please email onlineRCIcomplaint@dir.ca.gov

Employer or Business Information

RETALIATION COMPLAINT

EQUAL PAY ACT (EPA) COMPLAINT

PAY TRANSPARENCY COMPLAINT

Employer/Business Information

Employer Information

Employer/Business Type

Employer's Business Name

Employer's First Name

Employer's Middle Name

Employer's Last Name

Type of Industry

Employer still in business?

Total number of employees

Employer's Email

Email

Confirm Email

Employer's Phone

Phone Type

Please include area code, XXX-XXX-XXXX

Mobile Phone

Office Phone

Employer's/Business Address

Business Address

Do not copy and paste. Please spell out North, South, East, West.

Business City

Business State

Abbreviate State ex. CA, NY

Business Zip Code

Employer's/Business Address

Business Address

Do not copy and paste. Please spell out North, South, East, West.

Business City

Business State

Abbreviate State ex. CA, NY

Business Zip Code

Work Address or Location

Is your work address different from the business address provided?

Employer's Business Name (If different from above)

Add work address for complainant

Work Address

Do not copy and paste. Please spell out North, South, East, West.

Work City

Work State

Abbreviate State ex. CA, NY

Work Zip Code

Work Phone

Phone Type

Please include area code, XXX-XXX-XXXX

Mobile Phone

Office Phone

Person in Charge

Name of Person in Charge

Provide full name if possible. Partial and nicknames are ok.

Job Title/Position of Person in Charge

Add additional employer if more than one employer present at your workplace or responsible for your work. For example, if you work for a temp agency and are placed to work at a company, you may list both.

For technical support for this form only, please email onlineRCIcomplaint@dir.ca.gov

Retaliation Complaint Investigation Unit (RCI)

RETALIATION COMPLAINT

EQUAL PAY ACT (EPA) COMPLAINT

PAY TRANSPARENCY COMPLAINT

Retaliation

1. Please describe what happened and why you believe your employer took a negative action against you.

Please be detailed in describing what you did that you believe led to your employer's retaliation against you.

2. What negative action occurred to your employment as a result and when did it happen?

Describe the action.

2a.What date did your employer take the negative action against you? (MM/DD/YYYY)

3. What legal right did you exercise that you believe caused the negative action?

Describe what you did or what your employer believes you did that led to their retaliation against you.

4. Did your employer know you exercised a legal right before taking the negative action against you?

4a. How did your employer know?

5. Do you believe your employer took the negative action against because you exercised this legal right?

6. Who made the decision to take negative action?

	First Name	Last Name	Job Title(s)
Who made the decision?

7. Are other employees also filing retaliation claims against your employer?

8. Have you filed or do you plan to file a separate EPA (Equal Pay Act) complaint?

9. Did the employer or person(s) you listed as deciding the negative action, give you a reason?

10. What reason did they provide?

Childcare Facility

1. Do you work at a childcare facility?

2. Did you report issues related to the safety of the children in the facility?

Who was it reported to?

	First Name	Last Name	Job Title(s)	Date of Report (MM/DD/YYYY)
Reported to

3. Did you report these issues to the Department of Social Services or any other government agency?

Agency

Agency Name

Date of Complaint (MM/DD/YYYY)

What was reported?

4. Did you report any other violation of law or licensing?

Violation Reported to Person/Agency

	Agency	First Name	Last Name	Job Title(s)	Date of Report (MM/DD/YYYY)
Person/Agency

Immigration Threat

1. Did your employer make an immigration threat related to you?

Immigration threats are illegal regardless of your immigration status.

2. Who made the threat?

First Name

Provide full name if possible. Partial and nicknames are ok.

Last Name

Title

3. Who was the threat made to?

Other Person's First Name

Other Person's Last Name

Other Person's Title

Other Person's Phone Number

Please include area code, XXX-XXX-XXXX

4. How was the threat made?

5. Was anyone else present?

A potential witness to the immigration threat.

First Name of Witness

Last Name of Witness

Title of Witness

Phone Number of Witness

Please include area code, XXX-XXX-XXXX

6. When was the threat made? (MM/DD/YYYY)

Provide exact date or best estimate.

7. Describe the threat made.

8. Do you have evidence of this threat?

Describe the other evidence

Health and Safety

Health and Safety Complaint

1. Did you notice any health or safety issues in your workplace?

2. Did you have any concerns about these health or safety issues?

3. Did these health or safety issue(s) affect you or your coworkers?

4. Did you complain to anyone about these health or safety issues in your workplace?

Reported the issue to a coworker or anyone else at work.

5. Did you complain about these health or safety issues to your supervisor, manager, another agency, union representative, human resources, or anyone else with control over your employment at your workplace?

6. Are you filing this complaint because you believe your employer took a negative action (retaliated) against you for reporting these health or safety issues?

A negative action can include, but is not limited to, termination or suspension of employment, write-ups, reduction in hours, etc.

7. Please describe these health or safety issues and when they were reported:

Please describe what was concerning, how it affected you, and how your employer knew.

Work Related Injury

1. Did you experience a work-related injury or illness?

Were you injured or did you become ill at work while working.

2. Did you report the work-related injury or illness to your employer?

3. Are you filing this complaint because you believe your employer took a negative action (retaliated) against you for reporting this work-related injury or illness?

A negative action can include, but is not limited to, termination or suspension of employment, write-ups, reduction in hours, etc.

4. Please describe the work-related injury or illness, when it occurred, and when it was reported:

Please be detailed in describing when this occurred, who it was reported to, and how it was reported.

Issues Affecting All Workers

1. Did anyone from the Labor Commissioner’s Office come to your workplace?

2. Did you speak, listen, or interact with them in any way?

3. Do you think your employer took a negative action (retaliated) against you for doing so?

Independent Contractor(s)

1. Do you believe you were misclassified as an independent contractor(s)?

2. Did you report your belief of misclassification to your employer?

Which person/agency did you report it to?

	Agency	First Name	Last Name	Job Title(s)	Phone Number
Person/Agency

3. Do you believe you were retaliated against for reporting the misclassification?

Equal Pay Act (EPA)

1. Do you believe you were paid less than other employee(s) because you are a different |sex| or | race/ethnicity | or |both sex & race/ethnicity|?

2. Is it |sex| or |race/ethnicity| or |both sex & race/ethnicity|?

Other reason you were paid less

3. Do you perform the same or similar work as these other employee(s)?

Pay Details

Complainant Information. Please complete the table below by entering your information for each field.

	Name	Sex	Race/Ethnicity	Job Title(s)	Job Duties	Pay Frequency	Pay Rate
Complainant Information				Drag corner to expand text box	Drag corner to expand text box	Include all your compensation: wages, bonuses, commissions, other.	Include all your compensation: wages, bonuses, commissions, other.
Co-worker/Other Employees Information				Drag corner to expand text box	Drag corner to expand text box	Include all your compensation: wages, bonuses, commissions, other.	Include all their compensation: wages, bonuses, commissions, other.

4. Have you asked your employer why you are paid less than your co-worker(s)?

4a. What reason did they provide you?

5. Do you believe this reason to be true?

5a. Why do you believe this is not true?

6. Do you believe you have been retaliated against by your employer for discussing these issues under the Equal Pay Act?

File Retaliation Complaint

You must file a separate retaliation complaint. We will send you a link to file this complaint via email after you submit this form.

Pay Transparency

Pay Transparency Violation

1. What type of Pay Transparency Violation are you reporting?

I am reporting a job posting without a pay scale or salary or hourly wage range that may violate Labor Code section 432.3(c)(3) or 432.3(c)(5)I am reporting an employer that sought salary history information about an applicant for employment and/or relied on the salary history information of an applicant for employment as a factor in determining whether to offer employment or what salary to offer the applicant.I am reporting an employer that failed to provide the pay scale for a position upon request to an applicant applying for employment, or to an employee for the position in which the employee is currently employed.

I first learned of the job posting on (MM/DD/YYYY)

Job Posting Information

The job was posted on (Mark all that apply):

Employer’s websiteJob posting emailed by employer or third partyWebsite that advertises job postings for multiple employersOther job posting method:

Describe the other job posting method:

Job Posting Website Address

Attachments (Maximum of 5 files and 25MB size)

1. Provide copy of job posting (PDF, JPEG, etc)

2. Provide additional documentation if needed (PDF, JPEG, etc)

3. Provide additional documentation if needed (PDF, JPEG, etc)

4. Provide additional documentation if needed (PDF, JPEG, etc)

5. Provide additional documentation if needed (PDF, JPEG, etc)

Violation Details

2. Provide a detailed account of the violation.

Employment

At the time of the alleged violation in the 'Pay Transparency Complaint (PTC) section,' were you an applicant for employment with the employer listed in the 'employer information' section?

Did you apply?

Positions

I applied for the following position with the company:

on or about: MM/DD/YYYY

How did you apply for for the position:

I was seeking employment with the employer. I did not apply for a position with the company because:

Working for Employer

Have you ever worked for the employer listed in 'employer information section'

Dates

Date of Hire (MM/DD/YYYY)

Date Employment Ended (MM/DD/YYYY)

Job Title at time of the pay transparency violation:

If you do not wish to report a Pay Transparency Violation: STOP HERE, DO NOT FILL OUT THIS FORM AND CLOSE THE BROWSER/WINDOW.

Contact Information

Name of contact person

Job Title/Position Listed on Job posting

Contact person's phone

Please include area code, XXX-XXX-XXXX

Email address of contract person

example@example.com

Witnesses

Do you have witnesses to the workplace events described above?

Include anyone you think may have seen or experienced the same actions as you.

Add Witness

First Name

Last Name

Job Title

Job Duties

Please be detailed in describing major job duties.

Email

example@example.com

Phone

Phone Type

Please include area code, XXX-XXX-XXXX

Mobile Phone

Office Phone

Address

Street Address

Do not copy and paste. Please spell out North, South, East, West.

City

State

Zip Code

Please provide a brief explanation of what they saw/heard related to your complaint

Describe what you believe this person would have witnessed.

Remedies

Briefly describe what you hope happens as a result of filing the complaint.

Remedy or resolution you seek as a result of filing this complaint.

For technical support for this form only, please email onlineRCIcomplaint@dir.ca.gov

Submit

WARNING:

There was an error processing your complaint or this complaint has already been submitted and can not be submitted again.  If you feel this is an error please contact support at onlineRCIcomplaint@dir.ca.gov.

RETALIATION COMPLAINT

EQUAL PAY ACT (EPA) COMPLAINT

PAY TRANSPARENCY COMPLAINT

Authorizations to Release Information

Please click the 'Review' button to review your responses on the summary page. You may print a copy for your records from the summary page. However, to complete the process, you must click the ‘Confirm’ button for the data to be received by the Labor Commissioner’s Office. If you do not click the Review and Confirm buttons, your claim will not be filed, and you may miss your deadline to file with the Labor Commissioner’s Office.

Please only click the 'Review/Confirm' button once. Please do not close this window or click the Back button on your browser after clicking 'Review/Confirm' until the submission process has completed.

By submitting this form, I hereby certify that the information I have provided is true to the best of my knowledge and/or recollection, and I further acknowledge that this information is being collected by the State and may be shared with another state agency or a private party in accordance with California Civil Code section 1798.24 and the Information Practices Act of 1977 generally. For more information regarding the Department of Industrial Relation’s Privacy Policy, please go to www.dir.ca.gov/od_pub/privacy.html

Department of Industrial Relation’s Privacy Policy

Date and Time

For technical support for this form only, please email onlineRCIcomplaint@dir.ca.gov

Please click the 'Review and then Confirm' button to complete your complaint.