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Misclassification Report Form

Complete this Form if you think you or someone else is treated as an independent contractor instead of an employee. Please provide us with as much information as you can.  

Business Information
This should be the owner and/or primary company representative. This area should NOT include your information.
Business Address
Worksite Information
Work / Services Performed
Violation Information
Please provide all relevant details. This is your statement regarding alleged violations.
Other Involved Parties
Contact Information
This will allow us to follow up with you regarding the complaint in question. Your contact information is not required in order to file this complaint.
Contact Address Information
Please .zip files if you need to include more than two documents.