NYS Retaliation Complaint Form

Under New York State's Retaliation Law (New York State Labor Law Section 215), employees are protected when complaining about labor law violations, providing information to the Department of Labor, or participating in proceedings at the Department of Labor.

Do you feel you were retaliated against by your employer?

Yes

CLAIMANT INFORMATION

First Name

Last Name

Your physical address

Address Line 1

Address Line 2

City/Town

County

State

Zip Code

Is your mailing address different from your physical address?

Yes

Telephone Number

Alt Telephone Number

Email Address

Preferred Language

Can you write in your preferred language?

Yes

Can you read in your preferred language?

Yes

Do you need an interpreter or translator?

Yes