Employment entitlement complaint form

This publication is for: 
Employee / worker

This form is to be used as part of the process of making a complaint to Wageline at the Department of Mines, Industry Regulation and Safety about alleged underpayment of wages by an employer.

Details of how to use this form are on the Making a complaint about underpayment page of this website - it is essential that the steps outlined on that page are followed prior to completing this form. Wageline will not assist unless you have first attempted to resolve the issue with your employer (see step two and three).

To make a complaint about employment entitlements you must complete the Employment Entitlement Complaint Form above and attach supporting documentation which provides evidence of your complaint.

If your complaint also relates to long service leave, you will need to also complete the Long Service Leave Entitlement Complaint Form.

The PDF form is editable, however depending on your software you may not be able to save details entered into the PDF form. The PDF form needs to be printed off and signed, then a scanned copy emailed to Wageline - wageline@dmirs.wa.gov.au 

If you prefer to hand write your complaint, please use the Word version of this complaint form. You can then print, sign, scan and email the form to Wageline or post it to the address below. 

Wageline, Private Sector Labour Relations
Department of Mines, Industry Regulation and Safety
Locked Bag 100

Labour Relations
Form – application
Last updated 31 Jan 2020

Share this page:

Last modified: