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County Comptroller's Office
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Living Wage Complaint Form

You may fill out the form below, or print and mail the form to us. A printable version can be found here.

--Confidential--

Employee Complaint Form

Company/Organization Name:

Company/Organization Address

City   State    Zip

Phone  

Complaint relates to: (check all that apply) Wages   Health Benefits Paid Holidays   Retaliation for Making a Complaint

Describe your complaint:

Has Your Complaint Been Made to Your Employer?

OPTIONAL INFORMATION

Contract Number

Name of County Contract(s) that you have been working on:

Description of services you are performing under the Contract(s) named above:

Complainant Name:   

Date:

CONFIDENTIALITY NOTICE
All complaints made to the Living Wage Unit will be kept confidential.

If you have any questions about the Living Wage Law or you think you are a covered employee and are not
receiving the benefits you are entitled to under the Living Wage Law, please contact the Nassau County
Comptroller’s Living Wage Unit at (516) 571- 3668. 
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