COMPLAINT FORM

OVERVIEW
Employers must pay wages according to B.C. employment standards. Additionally, a variety of concerns are covered by the
Temporary Foreign Worker Protection Act. You can ask us to resolve concerns about an employer or recruiter by submitting a
complaint.

This process can take several months. We might be able to resolve your concerns by starting an investigation. Your concerns may be
shared with the employer.

Not every work issue, workplace or type of work is covered by employment standards.
You can find out if B.C. employment standards apply to your work situation.

BEFORE YOU START KNOW THE TIME LIMIT

Gather your documents Under the Employment Standards Act:
Any of the following documents you can provide will help
resolve your concerns: Working for the same employer. Issues will be reviewed from
up to one year before the date your complaint is received. You
• T4 income slip can ask that your complaint be kept confidential to protect your
• Record of Employment working relationship with your employer.
• Pay cheques, pay stubs or statements of wages
• Employment contracts or agreements Not working for the same employer. You must file your
• Work schedules or timesheets complaint within six months of your last day of work or the last
day of your temporary layoff. Issues from the last year of your
• Other documents with details about your complaint or
employment will be reviewed.
calculations
Under the Temporary Foreign Worker Protection Act,
Provide as much information as possible
a complaint must be submitted within 2 years of the date of the
Have copies of your documents available. Prepare any
alleged contravention.
additional details to help process your complaint.

Part 1 – About the employee SUBMIT YOUR COMPLAINT

• Information and contact details about the employee
For fast processing, we recommend submitting an online
• If the complaint is not about a specific employee skip
complaint form found at:
this part
[Link]/Complaints
Part 2 – About the employer(s)
• Information and contact details about the employer(s) You will receive an automatic email that confirms your
submission.
Part 3 – About your work
• Information about your work such as start and end
dates, wage rate and job description
You can also submit this application package by:
• If the complaint is not about a specific employee skip
this part
Mail: Employment Standards Branch
PO Box 9570 Stn Prov Govt
Part 4 – About your concern
Victoria, BC V8W 9K1
• Details about the concerns, the amount you think is
owed and potential resolution Toll-free fax: 1-855-490-0476
Part 5 – About the representative or third party Email: EmploymentStandards@[Link]
• Skip this part if you do not have a representative
• If you're filing on behalf of someone or the complaint
is not about a specific employee, provide your
information Need help filling out this form? Get help in the language of your
choice. Call toll-free 1-833-236-3700.

The personal information on this form is collected by the Province of British Columbia for the purposes of administering and enforcing the
Employment Standards Act and/or the Temporary Foreign Worker Protection Act under the authority of s. 26 (a), (c) of the Freedom of Information
and Protection of Privacy Act. If you have any questions about the collection of this information, please contact the Employment Standards
Branch at PO Box 9594 Stn, Prov Govt, Victoria, BC, V8W 9K4, by phone: 1-833-236-3700 or by email: EmploymentStandards@[Link].
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 COMPLAINT FORM
PART 1 – ABOUT THE EMPLOYEE
If you’re completing this form on behalf of a specific employee (including yourself), enter that person’s information on this page.
Skip this part if the complaint is not about a specific employee.
A – NAME
GIVEN NAME MIDDLE NAME (if applicable) FAMILY NAME

OTHER KNOWN OR USED NAMES (optional) PREFERENCE FOR BEING ADDRESSED (optional)

B – CONTACT INFORMATION
EMAIL ADDRESS I do not have an email address TELEPHONE NUMBER

STREET ADDRESS I do not have an address

ADDRESS LINE 2 (APARTMENT, SUITE, UNIT, ETC.) CITY

PROVINCE/STATE/REGION POSTAL/ZIP CODE COUNTRY

C – ADDITIONAL INFORMATION
DATE OF BIRTH (if under 19)
Are you under 19 years of age? Yes, I am under 19 No
yyyy / mm / dd

Do you consent to share your contact information with the employer? Yes No

We can keep your contact information private. For example, you may not want to share a new phone number or address if the employer
does not have your current information. If you want your name to remain confidential, you must tell us when you fill out the details about
your concern.

Do you identify yourself as First Nations, Métis or Inuit? Yes No Prefer not to answer

Do you require special accommodations?

Trouble understanding English

Visual impairment

Hearing impairment

Other special accommodations (please describe below):

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 COMPLAINT FORM
PART 2 – ABOUT THE EMPLOYER(S)
We need to contact the employer to resolve your concerns. We also need to know details about the business and employment
circumstances. If multiple employers are involved, you can copy this page and fill it out for each employer.
A – EMPLOYER INFORMATION
BUSINESS NAME (Legal name printed on T4 statement, Record of Employment or wage statement)

OPERATING NAME(S)

What does this business do?

Do any of the following apply? (check all that apply)

The business is closed The business is for sale or was sold The employer has financial difficulties

You worked for, or were paid by more than 1 business You were treated like an independent contractor

Does this employer provide housing or accommodation? Yes No

B – MAILING ADDRESS
STREET ADDRESS

ADDRESS LINE 2 (APARTMENT, SUITE, UNIT, ETC.) CITY

PROVINCE/STATE/REGION POSTAL/ZIP CODE COUNTRY

C – WORK LOCATION (If different from mailing address)

STREET ADDRESS

ADDRESS LINE 2 (APARTMENT, SUITE, UNIT, ETC.) CITY

PROVINCE/STATE/REGION POSTAL/ZIP CODE COUNTRY

D – CONTACT PERSON
Do you know anyone we could contact at the employer? Yes No
This could be someone like a supervisor, a manager or the owner of the business.

GIVEN NAME FAMILY NAME ROLE (For example: manager or owner)

EMAIL ADDRESS TELEPHONE NUMBER

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 COMPLAINT FORM
PART 3 – ABOUT THE WORK
If you’re completing this form on behalf of a specific employee (including yourself), enter that person’s work information on this page. Skip
this part if the complaint is not about a specific employee.
A – FOREIGN WORKER

Are you a foreign worker? Yes, I am a foreign worker No, I am a Canadian citizen or permanent resident

Foreign workers are individuals who are not Canadian citizens or permanent residents.
Foreign workers have additional protections under the Temporary Foreign Worker Protection Act.
Which foreign worker program was used to hire you?

B – START DATE AND ROLE

Did you perform any work for your employer? Yes No

START DATE ROLE AND RESPONSIBILITIES

yyyy / mm / dd

Are you still working for your employer? Yes No I am unsure

C – WAGES
RATE OF PAY (For example: “$16 an hour” or “$800 per month”) How many hours a week did you work on average?

Less than 20 hours Between 20 and 40 hours

More than 40 hours

Were you paid less than minimum wage? Yes No How were you paid? Cash Cheque

Direct Deposit E-transfer Other

Did you receive wage statements (pay stubs) from your employer? Yes No

D – END DATE AND REASON

What was your last day of work for your employer?
(If you don’t know the exact date, give an approximate date)
yyyy / mm / dd
If you’re no longer working for your employer, why did you leave?

I quit I was laid off Other (please describe):

I was fired The job was seasonal

Please describe what happened:

E – UNION

Did you belong to a union when working for your employer? Yes No I am unsure

UNION NAME

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 COMPLAINT FORM
PART 4 – ABOUT YOUR CONCERN
Please tell us about the situation. We know that this might be difficult to talk about, but it will help us get a better understanding of your
situation. The more detail you provide us, the easier it will be for us to investigate and resolve your complaint.
A –SITUATION
What is your concern about? (Select all that apply)

Getting paid for work Passports and official documents

Getting fired, laid off or quitting Fees for work

Vacation or statutory holiday pay Threats (such as deportation)

Deductions from wages, expenses, or gratuities Other (please describe):

Taking or returning from a leave

In your own words, describe the situation or attach a separate document:

How long has this been an issue, or when did it happen?

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 COMPLAINT FORM
B – RESOLUTION
How would you like this to be resolved?

Do you have an estimate of what you are owed? Yes No

If you answered “Yes” above, how much do you estimate you are owed? (You don’t need to consider taxes or other deductions)

To help us understand your concerns, tell us anything else you think we should know about your situation:

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 COMPLAINT FORM
PART 5 – ABOUT THE REPRESENTATIVE OR THIRD PARTY
Complete this part if:
• You have someone to help or represent you
• You are completing this form for someone else
• Your complaint is not about a specific employee
A – NAME

Is the complaint for more than one person? Yes No

GIVEN NAME MIDDLE NAME (if applicable) FAMILY NAME

OTHER KNOWN OR USED NAMES (optional) PREFERENCE FOR BEING ADDRESSED (optional)

B – CONTACT INFORMATION
EMAIL ADDRESS No email address TELEPHONE NUMBER

STREET ADDRESS No address

ADDRESS LINE 2 (APARTMENT, SUITE, UNIT, ETC.) CITY

PROVINCE/STATE/REGION POSTAL/ZIP CODE COUNTRY

C – RELATIONSHIP
Describe the nature of the representative or third party’s relationship (For example: lawyer, friend, family member):

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