Long service leave 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 a long service leave entitlement 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 steps two and three).

To make a complaint about a long service leave entitlement you must complete the Long Service Leave Entitlement Complaint Form above and attach supporting documentation which provides evidence of you complaint.

If your complaint also relates to underpayment of wages or other entitlements, you will need to also complete the Employment 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 25 Nov 2019

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