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Underpayment of wages or entitlements complaint form Page 1 of 6
Underpayment of wages or entitlements complaint form Use this form to make a complaint to Private Sector Labour Relations for underpayment of wages or leave entitlements under Western Australian state employment laws.
Private Sector Labour Relations is able to investigate alleged underpayments of:• WA award pay rates and leave entitlements;• minimum pay rates and leave entitlements under the Minimum Conditions of Employment Act 1993; and• long service leave entitlements under the Long Service Leave Act 1958.
Submitting your complaintTo assist Private Sector Labour Relations with assessing your complaint, please attach if available:• copies of any letters, emails or text messages that you have sent to your employer about your
underpayment issue, and any responses you received.• other documents that support your complaint such as payslips or records of the hours you worked.
Have you tried to contact your employer?
If 'No', why didn't you contact your employer?
If 'Yes', please attach a copy of the letter you sent to your employer and any responses you received from them, screen shots of text messages can also be attached and submitted with your complaint.
Yes No
Not Applicable YesHave you attached a copy of the letter to your employer?
Choose either one or both of the following options as necessary:
Underpayment of pay rates or leave entitlements other than long service leave.
Underpayment of long service leave entitlements.Is your employer's business a Pty Ltd, Ltd or Inc. company? Yes No
Provide details about the employment entitlements you are claiming you have not been paid or received:
I don't know
If these documents are not available, you can still submit the complaint form, however Private Sector Labour Relations may ask you to provide this documentation at a later stage.
Before you get startedBefore making a complaint to Private Sector Labour Relations about underpaid wages or entitlements, you should try to resolve this matter yourself by putting your concerns in writing to your employer.
What is your complaint about?
Employer's business phone number Employer's mobile number
Preferred Name
Suburb State Postcode Country
Date of birth
Your employer's detailsPlease provide us with details about your employer.
Your employer's business/trading name
What is the Australian Business Number (ABN) or Australian Company Number (ACN) for this business? You may find this on your payslip or your PAYG payment summary (Group Certificate).
Employer's or manager's name
Employer's email address
Employer's business address (this should be the physical location of the business premises)
Suburb State Postcode Country
Is the business still operating? Yes No I don't know
What type of business is it?
Was this business sold while you worked there? Yes No
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Your details
Please provide us with details about yourself.
First Name Last Name
Telephone/Mobile number
Email Address
Postal Address
Underpayment of wages or entitlements complaint form
If 'yes', what was the name of the previous owner of the business and when was it sold?
Underpayment of wages or entitlements complaint form Page 3 of 6
Employment type:
Your employment Please provide us with details about your employment.
When did you start/stop working for this business, or are you still working there? Start date End date
Still employed
If your employment has ended, did you resign or did your employer dismiss you?
Resigned Dismissed Dismissed for serious misconduct
Attached
Yes No
If 'Yes', please attach a copy of your contract or letter of employment. Are you employed as an apprentice or trainee?
Yes No
If 'Yes', what is the name of your apprenticeship or traineeship?
If 'Yes', please attach a copy of your apprenticeship or traineeship training contract. If you need a copy of your contract, contact the Apprenticeship Office at the Department of Training and Workforce Development on 13 19 54.
A copy of my apprenticeship or traineeship contract has been attached.
Are you in Australia on a visa?
Yes No
If 'Yes', please attach a copy of your visa and your passport entry to Australia. A copy of my visa has been attached.
A copy of my passport entry to Australia has been attached.
Full time Part time Casual
Did your employment type change? (e.g. casual to part time or full time)
Yes NoIf 'Yes', please provide details (e.g. you started with this business as a casual but later became full time).
What was your job title?
What were your usual duties?
Did you receive anything in writing offering you employment?
Underpayment of wages or entitlements complaint form Page 4 of 6
Did your normal weekly number of hours vary during your employment? Yes NoFor example, your normal weekly number of hours would vary if in your first 5 years of employment you normally worked 25 hours per week, but for the last 5 years you normally worked 35 hours per week.Did you take any long service leave? Yes No
If 'Yes', how much long service leave did you take and when did you take it?
Did you cash out any long service leave? Yes No
If 'Yes', how much long service leave have you cashed out and how much money did you receive for this?
If 'Yes', please attach a copy of the written agreement to cash out long service leave. An employee can agree to cash out accrued long service leave provided that the agreement is in writing and the employee receives an adequate benefit instead of the leave.
A copy of the written agreement to cash out long service leave is attached.
Did you take leave due to illness or injury for more than 15 days in any one year during your employment?
Yes No
If 'Yes', how many days leave due to illness or injury did you take and in which year/s?
Did you have any periods of leave without pay including parental leave? Yes No
If 'Yes', how much leave without pay did you take and when did you take it?
Complete this page only if your underpayment complaint relates to long service leave entitlements
Underpayment of wages or entitlements complaint form Page 5 of 6
Your pay Please provide us with details about your pay.
Did you receive payslips? Yes No
No
If 'Yes', please attach copies of your payslips and PAYG payment summaries (group certificates) if available. (Note that you can contact the Australian Taxation Office on 13 28 61 for copies of your PAYG payment summaries).
Copies of my payslips have been attached.
Were you employed on commission or piece rates? Yes If 'Yes', what are the details of your commission or piece rate agreement?
How much were you paid as a gross amount (before tax was deducted)? Please specify if the amount was paid per hour, per week or per fortnight.
How were you paid (e.g. direct deposit (EFT), cash etc.)?Direct deposit Cash Cheque Other
If you have selected 'Other', please specify.
How did your employer record the hours you worked?
Hard copy time sheets Time cards Sign-in book DiaryElectronic time sheets Roster I don't know Other
If you have selected 'Other', please specify.
How did your employer record how much you were paid?
Bookkeeper/Accountant Accounting software Wages bookI don't know Other
If you have selected 'Other', please specify.
Underpayment of wages or entitlements complaint form Page 6 of 6
Do you have any requirements that Private Sector Labour Relations should be aware of when we contact you?
IŜŀNJƛƴƎ ƛƳLJŀƛred Need an interpreter Have a disability OtherIf any box above is checked, please provide further information on how we can assist your communication:
DeclarationI declare that the information I have provided is true and correct to the best of my knowledge. I agree that my name and the information I have provided may, if necessary, be revealed in correspondence or investigations concerning my complaint.
I understand that an investigation is subject to the Private Sector Labour Relations Division Compliance and Enforcement Policy and as such Private Sector Labour Relations does not formally investigate every complaint it receives.
I understand and accept the declaration.
I understand the information I have provided will be managed in accordance with the Department's Privacy Statement.
What happens next?To lodge your complaint email a copy of the completed complaint form to [email protected]. Once your complaint has been received, a conciliation officer will work with you and then your employer to attempt to resolve the matter through conciliation.The conciliation process usually takes 21 days from when the conciliation officer first contacts you. A conciliation officer is impartial and does not represent either the employee or the employer. If your complaint is not resolved via conciliation, your complaint may be considered for formal investigation subject to public interest considerations as outlined in the Private Sector Labour Relations Division Compliance and Enforcement Policy.
