Public Integrity Unit Complaint Form

KINGS COUNTY DISTRICT ATTORNEY'S OFFICE
LABOR FRAUDS UNIT
350 Jay Street
Brooklyn, NY 11201
HelpLine 718-250-3770
Email: LFU@BrooklynDA.org
COMPLAINT FORM
COMPLAINANT
Your Name:
Home Telephone:
Home Address:
Cell Phone:
E-mail:
How may we contact you?:
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COMPLAINT
Name of person, company or other entity you are complaining about:
Phone (if known):
Address (if known):
Names and phone numbers of people who may have information relevant to your complaint :
--------------------------------------------------------------------------------------------------------------------------------------------------------Have you submitted this complaint to any other agency? [ ] Yes
[ ] No
If yes, agency name :
Please let us know if your complaint involves any of the following:
Failure to Pay Wages
Failure to Pay Minimum Wages
Failure to Pay Overtime
Failure to Pay Prevailing Wages
Workers' Compensation
Unemployment Insurance
Retaliation
Please provide a brief description of your complaint below (next page):
Please provide a brief description of your complaint below:
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