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WEST VIRGINIA DIVISION OF LABOR

REQUEST FOR ASSISTANCE

 

Are you a present employee:

GIVE A BRIEF DESCRIPTION OF WORK PERFORMED:

WHAT IS YOUR COMPLAINT:

Please give a description of the

item you wish the West Virginia Division of Labor to investigate.


WHAT AMOUNT OF WAGES OR FRINGE BENEFITS ARE DUE YOU:

BY MY SIGNATURE, I HEREBY CERTIFY THE ATTACHED INFORMATION TO BE TRUE AND ACCURATE.

WV Division of Labor Privacy Policy. For questions or to request a copy of our Privacy policy email laborprivacy@wv.gov.