The Earned Paid Sick Time Claim Form is used only for sick time accrual, noncompliance issues, usage, payment provisions, and/or failure to post the required notice in the workplace.
DO NOT use this form for any other issues (i.e. unpaid or missing wages, wages below the current minimum wage, mileage, unauthorized deductions, vacation, etc.).
INSTRUCTIONS FOR FILING AN EARNED PAID SICK TIME COMPLAINT
In order to best serve you, please follow these simple steps when filing your claim.
- The completed form can be submitted by: Email: [email protected], Fax: (602) 542-8097, or Mail.
- Claims must be filed within one (1) year from the date the wages were due.
- Please contact the Department immediately if you move and/or change your address.
- You must check one of the boxes on the second page, whether or not you consent to reveal your name to the employer.
- Answer all questions on the complaint form completely. Incomplete responses may delay or hinder the processing of your claim.
- All complaints must be signed by the claimant and dated before returning to the Department of Labor.
- Please provide one copy of the complaint form to the Department of Labor and retain a copy for your records. The Department is not responsible for the loss or damage of originals.
- Submit, with your complaint form, one copy of any documents that are relevant to your complaint and retain one copy for your records. These items may assist in the investigation process. TheDepartment is not responsible for the loss or damage of originals.
The Earned Paid Sick Time Claim Form is used only for sick time accrual, noncompliance issues, usage, payment provisions, and/or failure to post the required notice in the workplace.
DO NOT use this form for any other issues (i.e. unpaid or missing wages, wages below the current minimum wage, mileage, unauthorized deductions, vacation, etc.).
