Instructions for Filing an Epst/minimum Wage Retaliation Claim
The EPST/Minimum Wage Retaliation Claim Form may be used only for allegations of discrimination or retaliation under Arizona’s earned paid sick time or minimum wage laws. Do not use this form to report earned paid sick time violations related to accrual of earned paid sick time, noncompliance issues, usage of earned paid sick time, earned paid sick time payment disputes, or failure of an employer to post the required earned paid sick time notice in the workplace. In addition, do not use this form to report discrimination or retaliation that is related to age, disability, equal pay/compensation, genetic information, national origin, pregnancy, race/color, religion, sex, or sexual harassment. For more information about filing these type of claims, please visit the Equal Employment Opportunity Commission athttps://www.eeoc.govor the Arizona Civil Rights Division athttps://www.azag.gov/civil-rights.
The EPST/Minimum Wage Retaliation Claim Form must be filled out as completely as possible, including all required fields. Failure to provide required information may delay or result in dismissal of your claim.
To avoid delay in processing a retaliation claim, the EPST/Minimum Wage Retaliation Claim Form must state the legal name of the claimant’s employer, as indicated on a paystub or tax form. The claimant may submit a paystub, tax form, or other documentation to assist the Labor Department in identifying the correct employer
The EPST/Minimum Wage Retaliation Claim Form must be signed and dated by the claimant. Electronic signatures will be accepted.
Please attach to your EPST/Minimum Wage Retaliation Claim Form copies of any documents or evidence supporting your claim. Evidence of discrimination or retaliation may assist in the investigation process and expedite resolution of your Retaliation Complaint. Please do not send originals of documents or evidence to the Labor Department. The Labor Department is not responsible for the loss or damage of originals.
The completed EPST/Minimum Wage Retaliation Claim Form can be submitted: (1) Electronically by completing the Sign and Submit Form below; (2) by e-mail to [email protected]; (3) by Fax to (602)-542-8097; or (4) by U.S. Mail to Labor Department, P.O. Box 19070, Phoenix, AZ 85005-9070.
An EPST/Minimum Wage Retaliation Claim Form must be filed within one year from the date the alleged violation occurred or the date the employee knew or should have known of the alleged violation. Claims pertaining to violations outside of this one-year period will be dismissed.
You must notify the Labor Department immediately if you move or change your address, e-mail address, or telephone number.