The complaint form that WorkForce West Virginia links from its Foreign Worker Resources page is the Complaint/Apparent Violation Form, a U.S. Department of Labor, Employment and Training Administration (ETA) form. You use it to report a violation of your rights, such as unpaid or incorrectly paid wages or poor or dangerous housing or working conditions, and you can report anonymously. On FillingPDF you can fill out the form online and download or print the completed PDF; the official PDF is published at workforcewv.org.
Last updated
What is Complaint/Apparent Violation Form?
The Complaint/Apparent Violation Form is a U.S. Department of Labor, Employment and Training Administration (ETA) form for reporting a complaint or an apparent violation; WorkForce West Virginia posts it as its Complaint Form.
The form has two parts. Part I is completed by the person reporting: the complainant's contact information, the respondent's information, a description of the complaint or apparent violation (line 8a), an optional designation of a representative (line 8b) and a certification with signature and date. Part II. For Official Use Only is completed by the office that receives the report. It records whether the complainant is a migrant or seasonal farmworker, the issues involved (for example wage related, housing, health/safety, discrimination, trafficking, sexual harassment/coercion/assault), referrals to other agencies, actions taken and whether the matter was resolved locally.
The form states that complaints covered through the Employment Service and Employment-Related Law Complaint System are governed by 20 CFR 658 Subpart E, and it points to 20 CFR 651.10 for the definition of "Respondent". It carries OMB Approval No. 1205-0039, with an expiration date of 02/28/2027.
WorkForce West Virginia's Foreign Worker Resources page, which covers the H-2A and H-2B programs, tells workers to complete this form to report violations of their rights. The form is not a job application or a certification request.
Who needs to file Complaint/Apparent Violation Form?
Anyone whose rights have been violated can complete the form. The WorkForce West Virginia page lists the situations it is meant for:
- violation of your employee rights;
- knowledge of possible human trafficking;
- an employer refusing you access to your passport;
- not being paid correctly;
- poor or dangerous housing or working conditions.
The form names the respondent as a person, company or agency, an employer or a One-Stop Office, so it can be used against an employer or against an office. Part II also asks whether a complainant against an H-2A or criteria employer is a U.S. worker or an H-2A worker.
Anonymous reports. If you submit the form as an Apparent Violation, your name may remain anonymous, you do not need to fill out lines 2a and 2b, and no signature is required at line 9.
Representatives. A complainant may designate an individual to act as a representative. Enter that person's name, phone number and address on line 8b. If you submit the form as a complaint and a designated representative acts for you, the representative signs at line 9.
Complainants do not complete Part II; it is for official use.
When to file Complaint/Apparent Violation Form
Complete the form when you have a violation of your rights to report, such as those the WorkForce West Virginia page lists: incorrect pay, refusal of access to your passport, possible human trafficking or poor or dangerous housing or working conditions. No deadline is printed on the form, and the agency page sets none.
The agency page says to speak with WorkForce West Virginia outreach staff during their next visit or to complete and submit the form, so you can file when staff are on site or at any time you are ready to submit it. If you need more room to describe the problem, prepare separate sheets before you submit. The form is valid for use until the expiration date printed on it, 02/28/2027.
Documents you need
- Separate sheet(s) of paper with the rest of your description, attached to the form, only if the space on line 8a is not enough.
How to fill out Complaint/Apparent Violation Form
Decide complaint or apparent violation
The form is used both for a complaint and for an apparent violation. Decide which you are submitting, because an apparent violation lets you stay anonymous and skip lines 2a, 2b and the signature at line 9.
Enter the complainant's name
On line 1, write the complainant's name as Last, First, Middle Initial. For an apparent violation the name is not necessary and may remain anonymous.
Enter addresses and phone numbers
Give the permanent address on line 2a (No., St., City, State, ZIP Code) and a temporary address on line 2b if appropriate. Add the permanent telephone on line 3a and the temporary telephone on line 3b.
Identify the respondent
On line 4, enter the person, company or agency the complaint is made against. On lines 5 to 7, add the employer or One-Stop Office name if different from line 4, its address and its telephone number.
Describe the complaint
On line 8a, describe the complaint or apparent violation. If you need more space, use separate sheet(s) of paper and attach them to the form.
Name a representative if you use one
On line 8b, enter the name of the person you authorize to act on your behalf, plus that person's phone number and address. Leave it blank if you have no representative.
Read the certification and sign
The certification says the information is true to the best of your knowledge and authorizes disclosure to other enforcement agencies for the investigation. Sign on line 9 and enter the date on line 10; no signature is required for an apparent violation, and a designated representative signs on a complaint.
Leave Part II blank
Do not fill in Part II. For Official Use Only, including the complaint number, date received, issues involved, referrals and actions taken.
Review and download the completed PDF
Check the respondent details, the description and any attached sheets, then download or print the completed PDF from FillingPDF and submit it through the channels described under How to submit.
How to submit Complaint/Apparent Violation Form
You can give the completed form to WorkForce West Virginia, or contact the U.S. Department of Labor directly.
- WorkForce West Virginia: the agency page says to speak with its outreach staff during their next visit, or to complete and submit a Complaint Form. The page gives no mailing address or online upload for the form itself. For questions about foreign labor certification, the agency lists [email protected].
- U.S. Department of Labor Wage & Hour Division: the agency page also lists the phone number 1-866-487-9243 and the website www.dol.gov/whd as another way to report.
Attach any separate sheets you used for line 8a. The Washington, DC address printed in the Public Burden Statement is for comments about the time needed to complete the form, not for sending complaints. Complaints can be filed anonymously, and the form's certification says your identity is kept confidential to the maximum extent possible, consistent with applicable law and a fair determination of your complaint.
FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Filling in Part II. For Official Use Only; that section is completed by the office receiving the complaint, not by the complainant.
- Running out of room on line 8a and writing outside the box instead of using separate sheet(s) of paper attached to the form.
- Naming a representative in conversation but leaving line 8b blank; the representative's name and contact information must be provided there.
- Having a designated representative file a complaint on your behalf without the representative signing at line 9.
- Leaving the respondent's name, employer or One-Stop Office address and telephone number (lines 4 to 7) blank, so the complaint cannot be directed to anyone.
- Mailing a complaint to the Washington, DC address in the Public Burden Statement, which is only for comments about the burden estimate.
- Thinking you must give a name, permanent address or signature to report an apparent violation; the form says these may be omitted.
Frequently asked questions
What is the complaint form from WorkForce West Virginia?
It is the Complaint/Apparent Violation Form, a U.S. Department of Labor Employment and Training Administration form that WorkForce West Virginia tells workers to complete to report violations of their rights, such as incorrect pay, passport withholding or unsafe housing.
Can I file the complaint form anonymously?
Yes. WorkForce West Virginia says complaints can be filed anonymously. On the form, if it is submitted as an Apparent Violation, the complainant's name may remain anonymous, lines 2a and 2b can be skipped and no signature is required at line 9.
What problems can I report on this form?
The agency page lists violation of your employee rights, knowledge of possible human trafficking, an employer refusing you access to your passport, incorrect pay, and poor or dangerous housing or working conditions.
Can someone else file the complaint for me?
You may designate an individual to act as your representative. Enter the representative's name, phone number and address on line 8b. If the form is submitted as a complaint through a designated representative, that representative signs at line 9.
Where do I send the completed complaint form?
WorkForce West Virginia says to speak with its outreach staff during their next visit or to complete and submit the form; it gives no mailing address for it. You can also contact the U.S. Department of Labor Wage & Hour Division at 1-866-487-9243 or www.dol.gov/whd.
Will my identity be kept confidential?
The certification on the form says your identity is kept confidential to the maximum extent possible, consistent with applicable law and a fair determination of your complaint. It also authorizes disclosure to other enforcement agencies for the proper investigation of the complaint.
Can I fill out the complaint form online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent of WorkForce West Virginia and the Department of Labor and does not submit your complaint; you submit it through the agency's channels.
Ready to fill out Complaint/Apparent Violation Form?
Fill out Complaint/Apparent Violation Form now