Department of Labor Forms and Instructions

Instructions for accessing the forms on this page

The North Dakota Department of Labor utilizes a number of forms to gather information relating to potential violations of labor or human rights laws.

Most of the forms below are "fillable." Please note that information typed into fillable forms will be lost when the document is closed. Therefore, you are advised to fully complete the form and print it before closing.

Employment and Age Certificate (State Form 4598 - 75 kb pdf)
[Form 4598] [4598 Instructions]

Claim for Wages (State Form 17081 fillable - 60 kb pdf)
[Form 17081] [Preliminary Procedures] [17081 Instructions]

Complaint Inquiry (State Form 52114 fillable - 65 kb pdf)
[Form 52114] [52114 Instructions]

Employment Discrimination Questionnaire/Affidavit (State Form 14543 fillable - 161 kb pdf)
[Form 14543] [14543 Instructions]

Employment Retaliation (Whistleblower) Questionnaire/Affidavit (State Form 54049 fillable - 74 kb pdf)
[Form 54049] [54049 Instructions]

Housing Discrimination Intake Questionnaire (State Form 52229 fillable - 135 kb pdf)
[Form 52229] [52229 Instructions]

Human Rights Discrimination Intake Questionnaire (State Form 52974 fillable - 106 kb pdf)
[Form 52974] [52974 Instructions]

Independent Contractor Verification Application (State Form 58394 fillable - 773 kb pdf)
[Form 58394] [58394 Instructions]

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