CUSTOMER    COMPLAINT/ SUGGESTION   FORM

DEPARTMENT OF LABOR OF THE UNITED STATES VIRGIN ISLANDS
Office of the Commissioner
2203 Church Street
Christiansted St Croix, VI 00820-4612
(340)773-1994
Fax(340)773-0094		 P.O. Box 302608
St. Thomas, VI 00803-2608
(340)776-3700
Fax(340)774-5908
In order for the Department of Labor, to initiate an investigation of possible violations of the law, registration or certification laws and regulations of the Territory by a claimant, injured worker, job seeker, registrant, employer, EDC certificate holder, or other party, the complainant must complete all pages of this form.  Complaints must be typewritten or clearly printed in black or blue ink, if not delivered telephonically. Please state the facts briefly, clearly and with specificity.  Be sure to have available any documents, photos, or other evidence you have to support your complaint.
SUBJECT OF COMPLAINT/SUGGESTION:  
TYPE (S) OF COMPLAINT/ AREA OF SUGGESTION:
Unemployment Claim Discrimination Labor Relations Fraud (UI) (WC) (UE)
Workers Comp Claim Wrongful Discharge Wage & Hour Internal
Other (PLEASE SPECIFY)  

A. COMPLAINANT INFORMATION
Last Name First Name M I
Street Address
City State Zip Code
Contact Phone
()
Email Address, if any
If needed, are you willing to support your complaint by appearing at a hearing?
Yes No
  
B. NAME/ADDRESS OF WITNESS
Last Name First Name M I
Street Address
City State Zip Code
Contact Phone
( )
Email Address, if any
If needed, is this witness willing to support your complaint by appearing at a hearing?
Y es  No
*NOTE: If additional witnesses are available, list names, addresses & other pertinent data in a manner similar to above on regular paper.


C. DOL DIVISION INVOLVED
Name
Street Address
City State Zip Code
Phone (Please include area code)
( )
Proprietor
Type of Business
Email Address, if any
 
D. INDIVIDUAL INVOLVED
Last Name First Name M I
Street Address
City State Zip Code
Phone (Please include are code)
( )
Business type/Number
Profession of Licensee
Email Address, if any
E. Description of Complaint/Suggestion

Please describe your complaint in detail in the space provided below. Include in your complaint the dates, times and locations where offenses are alleged to have occurred.

Date of Offense:

          

For more information on the complaint process or to view the laws. rules and regulations of a board or commission, please visit the Department of Labor's website at: www.vidol.gov

vidol.gov