The Official Website of the Attorney General of Massachusetts

Martha Coakley, Attorney General

Non-Payment of Wage and Workplace Complaint Form


Office of the Attorney General
Fair Labor Division
One Ashburton Place
Boston, MA 02108

If your request is urgent or you need assistance filling out this form, please call the Fair Labor Hotline at (617) 727-3465. Please note that all fields denoted by * are required unless otherwise noted.

Employee Information:


  
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Employer Information:


  
 
  
 
  
  
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Reason for Filing Complaint:


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Instructions:


Please attach copies of any documents that support your claim, such as pay stubs and work logs. You will have an opportunity to provide these documents electronically on the confirmation page you receive after submitting your complaint.

If you elect to mail supporting documents in on paper, DO NOT SEND ORIGINALS. Your documents will NOT be returned to you. Please retain a copy for your records and send us photocopies of any documentation you think may be helpful in resolving the complaint. Please be sure to print a copy of your submitted complaint and attach it to the supporting documents.

Please do NOT include financial account numbers, credit or debit card numbers, your complete social security number, etc., or other sensitive personal information. We will contact you if we need any of this information.

Read the Following Before Signing Below:


I. Disclosure of Your Complaint.
Public Record. Under most circumstances, your complaint, and any documents submitted with your complaint, will be considered a public record and available to any member of the public upon request. In response to such a request, we generally will not disclose your name, address, phone number, or any other information that identifies you and will not disclose this form in response to any request that specifically seeks the complaint you submitted.
 
Disclosure to the Employer. In order to resolve your complaint we may release any and all information with regard to this complaint, including the form itself, to the employer you are complaining about. However, we will not disclose your contact information.
 
Disclosure to Other Entities. Your complaint and any related information may be disclosed in its entirety to other law enforcement and regulatory agencies.
 
II. Consulting With a Private Attorney.
The AGO cannot give you legal advice and is not able to be your private attorney, but represents the public interest. If you have any questions concerning your individual legal rights or responsibilities you should contact a private attorney.
 
 
By filling in my name above and checking this box, I acknowledge that I have read and understood the provisions above and certify that the information I have provided is true and correct to the best of my knowledge, and I adopt this as my online signature.