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

Division of Labor Standards

Attn: Prevailing Wage Program

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

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

Email: prevailingwage@labor.mo.gov

www.labor.mo.gov/DLS/prevailingwage


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

Complainant Information
* The "Asterisk" Denotes Required Field

Date

12/03/2021

 
 
 
 
~ Please provide email address for confirmation and correspondence about this complaint.


 
Type of Complaint
 
Project Identification - Complaint Against
 
 
 
 


Time employed on this project
 
 
Type of Project
 
 
 
 
 
Pursuant to RSMo. 290.290 MODLS can only pursue administrative action for one (1) year from final project payout.
 
Complaint Summary & Supporting Documentation
Supporting Documentation
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.

 
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 belief.