The Legal Arizona Workers Act Complaint Form

ADVERTISEMENT

Page 1 of ___
Legal Arizona Workers Act
Prescribed Complaint Form
Knowingly submitting a false and frivolous complaint is a Class 3 misdemeanor,
punishable by a fine of up to $500 plus other costs and up to 30 days in jail.
A complaint based solely on race, color or national origin will not be investigated.
Instructions:
1.
This complaint form is prescribed by the Arizona Attorney General’s Office pursuant to Arizona
Revised Statutes §§ 23-212(B) and 23-212.01(B). You may use this form to make a complaint either
to the County Attorney of the county where an unauthorized alien worker is or was employed, or to
the Arizona Attorney General’s Office, Attention Investigations. The final page of this form provides the
address and telephone number of each County Attorney and the Arizona Attorney General’s Office. Mail
the completed form to the appropriate address from the final page. If you have any question about this
form, please direct your question to the office where you intend to send your completed form.
2.
The law does not require you to use this complaint form, nor does the law prohibit anonymous
complaints. However, if you submit a complaint by telephone or e-mail or if you use a different
complaint form or if you use this form but refuse to provide your contact information and signature or
if you make some other form of anonymous complaint, your complaint may or may not be
investigated, at the discretion of the investigative agency. If you intend to submit your complaint to a
County Attorney, but do not wish to use this form, you should contact that County Attorney’s office to
determine how to submit your complaint.
3.
Please use a black or blue pen and PRINT clearly.
4.
Please complete all sections of this form that you can, using additional pages if necessary. If you do
not know the requested information, write “unknown.” Do not guess or make up information.
Employer:
After December 31, 2007, the following employer hired one or more unauthorized alien
workers as employees and/or independent contractors:
Name of employer: ____________________________________________________________
Type of business: _____________________________________________________________
Address where the unauthorized alien worker is or was employed: _______________________
____________________________________________________________________________
Employer’s phone number: ______________________________________________________
Names of managers, supervisors, or others who are familiar with employer’s hiring practices:
____________________________________________________________________________
Does the employer have one or more business licenses? _____ If so, what licenses? _______
____________________________________________________________________________
Rev 6/08 p1

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 4