Division of Labor Standards
Minimum Wage Complaint Form

This complaint form should only be completed for issues with the underpayment of wages, overtime compensation and not receiving your last paycheck, even if your hourly rate of pay is above minimum wage.


Sections 290.500-290.530, RSMo


To submit this form electronically, complete form and click "Submit Form" at the bottom of the form.

"*" Indicates Required Fields


If you have a preferred prefix/salutation (Mr., Ms., etc.), please enter it in the Suffix field.

To mail, print and complete this form and send to:


Division of Labor Standards

Attn: Minimum Wage Program

P.O. Box 449, Jefferson City, MO 65102-0449

Phone: 573-751-3403   Fax: 573-751-3721

Email: minimumwage@labor.mo.gov

www.labor.mo.gov/DLS/minimumwage


When using this form, please use one of the following web browsers: Microsoft Edge, Google Chrome, or Mozilla Firefox.

 
Minimum Wage Complaint Form

Date

04/18/2024


Note:
Please provide email address for confirmation and correspondence about this complaint.
By signing the verification below, I waive my right of confidentiality pursuant to Section 290.520 and authorize the Division of Labor Standards to use my name during the investigation of my complaint.
$
 

 
Pursuant to RSMo. 290.527 MODLS can only pursue administrative action for two (2) year from end of employment.
 
 
Attachments must not exceed 20 MB and must be one of the following types: .doc, .docx, .xls, .xlsx, .txt, .jpg, .jpeg, or .png

If you are unable to attach the documentation electronically, please indicate below in the "Summary of Complaint" a brief description of documentation you have. An investigator may contact you and ask to have it mailed or faxed to our agency if the documentation is needed.

Please provide a brief description of your job duties and explain why you feel you have not been appropriately paid under the Missouri Minimum Wage Law
Max # of Characters: 2000
 
By entering my name and submitting this electronically, I do hereby affirm under penalties of perjury that the above-stated information is true and correct to the best of my knowledge, information, and behalf.