Complaint form for unpaid wages or leave entitlements

This publication is for: 
Employee / worker

This form is to be used to make a complaint to Private Sector Labour Relations at the Department of Mines, Industry Regulation and Safety about alleged underpayment of wages or leave entitlements (including long service leave entitlements) by an employer.

Before making a complaint to Private Sector Labour Relations about underpaid wages or entitlements, you should first try to resolve the issue with your employer (see steps two and three).

The PDF form needs to be emailed to Wageline at The PDF form is editable, however depending on your software you may not be able to save details entered into the PDF form. If this is the case, you will need to print off and complete the form then email a scanned copy to Wageline.

Labour Relations
Form – application
Last updated 20 Jan 2021

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