State Form Number (SFN) 52114
- SFN 52114 Form (pdf)
Instructions for SFN 52114
A Complaint Inquiry form should be used in cases involving the reporting of a violation of a labor and/or human rights law and issues such as breaks, pay stubs, and the receipt of a final paycheck where the amount of the wages is not in dispute.
A Complaint Inquiry form should not be used for the collection of wages due or to file an individual complaint of discrimination. To file a claim for wages, use SFN 17081. To file a complaint of discrimination concerning employment, use SFN 14543. To file a complaint of discrimination concerning housing, use SFN 52229. To file a complaint of discrimination concerning public services/public accommodations, use SFN 52974.
The Complaint Inquiry form should be completed either by someone directly affected by the situation or someone who has directly witnessed the situation. Please complete all items on the form. No action will be taken on incomplete or unsigned forms. If the space provided on the form for an explanation is insufficient, feel free to attach additional pages. Also, provide any available documentation to support the complaint with the completed form.