Government of New Brunswick

Please complete and submit the online form below.

 

 

Section A - Information about you

 

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* Include at least one phone number.

 

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Section B - Your work history with your employer

 

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(YYYY-MM-DD)

 

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 Still employed
 
 
 Fired
 
 
 Quit
 
 
 Laid off

 

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 Daily
 
 
 Weekly
 
 
 Bi-weekly
 
 
 Semi-monthly
 
 
 Monthly

 

 

 

Section C - Information about this employer

 

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 Yes
 
 
 No
 
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Section D - Nature of complaint

 
 Minimum wage
 Minimum wage overtime
 Prompt payment / Unpaid wages
 Unauthorized deductions
 Paid public holiday

 

 

 

 
 Termination pay / Pay in lieu of
 Notice of termination
 Tips & gratuities
 Vacation / Vacation pay
 Maternity / Child care leave
 Other (please specify)
 

 

 

Section E - Details of your complaint

Was this complaint discussed with your employer?

 
 Yes
 
 
 No

 

 

Do you have relevant documents to support your complaint?

 
 Yes
 
 
 No

 

 

 

Are you covered by a collective agreement?

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 Yes
 
 
 No

 

In dealing with your complaint, do you give us permission to disclose your name?

 

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 Yes
 
 
 No

 

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By clicking “Submit”, I certify that all information provided is true and correct to the best of my knowledge.