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Complaint record sample

Complainant complaint 2026

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4.8 out of 5

45 votes

The document is a complaint/referral record form used by the U.S. Department of Labor's Employment and Training Administration for individuals to report complaints related to One Stop Career Centers (OSCC). It collects information about the complainant, the respondent, and the nature of the complaint, including various types of violations such as wage issues, discrimination, and working conditions. The form also includes sections for agency referrals and follow-up actions.

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Click ‘Get Form’ to open the complainant complaint in the editor.
Begin by filling out Part I, which includes your personal information. Enter your name, permanent address, and contact details in the designated fields.
Next, provide information about the respondent. Fill in the name of the person you are filing a complaint against and their employer's details.
In the 'Description of Complaint' section, clearly outline your concerns. If more space is needed, attach additional sheets as necessary.
Certify that all provided information is accurate by signing and dating the form at the bottom of Part I.
For OSCC use only, complete Part II by indicating if you are a migrant or seasonal farmworker and selecting appropriate boxes for your type of complaint.
Finally, review all entries for accuracy before submitting your completed form through our platform.

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Versions	Form popularity	Fillable & printable
2012	4.8 Satisfied (45 Votes)
2012	4 Satisfied (59 Votes)

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