Child Labor Complaint Form

The red asterisk (*) indicates required information

Your Information

I wish to remain anonymous

First Name

Last Name

Address

City

State

Zip

Phone

Email

Business Being Reported

What is your relationship to the business?

Current Worker

Former Worker

Parent/Guardian

Other

Business Name

Owner and/or Manager's Name

Address

City

State

Zip

Phone

Email

Complaint Information

Please provide any explanation or information that would be helpful to the Nebraska Department of Labor in the investigation of this complaint.

Include names and ages of any minors that may have been employed in violation of child labor laws.

By submitting this complaint, I certify the information provided is true to the best of my knowledge and belief. I understand the Nebraska Department of Labor may share the information contained in this complaint with any other government office or agency necessary to fully resolve this complaint.

Date