Fillable Complaint Labor Industries Who can file a complaint? (Washington)

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Complaint Labor Industries Who can file a complaint? (Washington)

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-..,
Washington
State
Department
of
,
Labor
&
Industries
Equal Pay and Opportunities Act
Complaint
Under the Equal Pay and Opportunities Act (EPOA) pay and career advancement opportunities cannot be
based on gender. EPOA prohibits gender pay discrimination and promotes fairness among workers by
addressing business practices that contribute to gender pay gaps. Employees and applicants have different
rights under this law.
Who can file a complaint?
As an employee, you can file a complaint if your employer (or former employer) has:
• Provided you with unequal compensation compared to other employees who are similarly employed, based on
gender.
• Limited or denied career advancement opportunities, based on gender.
• Prohibited you from discussing wages.
• NOT provided you with wage or salary information for your new position after you were offered an internal
transfer or promotion and requested the information. (Applies to employers with 15 or more employees only)
• Retaliated against you for filing a complaint, testifying in an EPOA proceeding, or exercising your rights under
EPOA.
As an applicant, you can file a complaint if an employer with whom you have applied for a job has:
• Sought your wage or salary history.
• Required your wage or salary history meet certain criteria, such as requiring that you made a minimum salary
previously in order to be eligible to apply for a new position.
• NOT provided you with the minimum wage or salary of the position you applied for after you were offered the
position and requested the information. (Applies to employers with 15 or more employees only)
For more information, go to: www.Lni.wa.gov/EqualPay
How to file an Equal Pay and Opportunities Act complaint:
• Complete and sign the attached form. Attach a separate sheet of paper if you need more space to explain your
complaint.
• Attach any additional information or records related to your complaint, such as pay statements, personnel
information, or employer correspondence (including emails and text messages). This is very important to
help us understand your complaint.
• Mail your complaint form to:
Department of Labor and Industries
Employment Standards
PO Box 44510
Olympia, WA 98504-4510
Or
Bring your complaint form to your nearest L&I office.
! Important: If you move or get a new phone number after filing a complaint, call L&I right away at
1-866-219-7321 to prevent delays in the investigation.
What happens after you file a complaint?:
L&I will review the information you provided to determine if your complaint can be investigated. If so, we will:
• Assign an Industrial Relations Agent to investigate your complaint. Due to the nature of this law, L&I will need
to tell the employer that you filed a complaint.
• If we determine that you are owed money, L&I will attempt to collect the money owed; however, we cannot
guarantee that we can collect it for you.
! Important: You also have the right to file private legal action against an employer for violations of
this law. However, L&I cannot investigate the complaint if a civil complaint is filed in court.
F700-200-000 Equal Pay Opportunity Act Complaint Form 07-2019
-..,
Washington
State
Department
of
,
Labor
&
Industries
I
I I
I I
I
I I I
I
I I
Equal Pay and Opportunities Act
Complaint
Employment Standards Program
360-902-5316 or 1-866-219-7321
WA Unified Business Identifier (UBI):
CATS #:
A: Worker Information
Language Preference
English
Spanish
Russian
Korean
Laotian
Chinese Traditional
Chinese Simplified
Cambodian
Vietnamese
Other:
Name (Last, First, MI)
Social Security Number (optional)
Home Phone Number
Cell Phone Number
Email Address
Home Address Street
City
State
Zip Code
Starting Date with this Employer
Are you still employed with this Employer
Yes
No
If not, last date employed
Reason for Leaving:
Fired
Quit
Laid Off
Don’t Know/Other:
What kind of work do you or did you do for this employer:
B: Employer Information
Name of Company
Name of Company Owner, Manager, or Supervisor
Company Phone Number
Company Cell Number
Company Fax Number
Company Email Address, if known
Company Mailing Address Street
City
State
Zip Code
Address where you worked if not the same as above Street
City
State
Zip Code
Has the company filed for bankruptcy?
Yes
No
Don’t know
Is the company still in business?
Yes
No
Don’t know
C: Equal Pay and Opportunities Act Complaint:
Select the violations of employee rights that you believe occurred:
Unequal compensation, based on gender
Prohibited Wage discussion
Retaliation
Limited or denied career advancement opportunities, based on gender
Not providing wage or salary information of a new position or promotion
Select the violations of applicant rights that you believe occurred:
Seeking wage or salary history
Requiring wage or salary history to meet criteria
Not providing minimum wage or salary information of a new position
Please attach additional documentation to explain your complaint in more detail
We need contact information for someone who will always know how to reach you (Not your own
D. If We Cannot Reach You
address or phone number.)
Your Contact’s Name
Address
City
State
Zip Code
Home Phone Number
Cell Phone Number
Work Phone Number
REQUIRED WORKER’S SIGNATURE
To the best of my knowledge, the information I have entered on this form is true and accurate.
Signature
Date
For more information about your workplace rights and responsibilities in Washington, to go: www.Lni.wa.gov/WorkplaceRights
F700-200-000 Equal Pay Opportunity Act Complaint Form 07-2019
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Completed 12 December 2020

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