Mandatory Overtime Complaint Form

The Great Seal of the State of New Jersey

NEW JERSEY DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT

DIVISION OF WAGE AND HOUR COMPLIANCE

PO BOX 389

TRENTON, NEW JERSEY 08625-0389

Employee Information
(First, Middle, Last)
The complete name of a person filing a complaint against an employer mandatory overtime
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
Street Address the federal identification number from the social security administration for the person who is making complaint against employer
-- (xxx-xx-xxxx)
(333)333-3333
(333)333-3333
Indicate that your employment involves direct care activities or clinical services
To indicate if you are an hourly employee
Hourly rate of pay

(** indicates a required field)

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