Government of New Brunswick

Please complete and submit the online form below.
* The fields with the asterisks are mandatory

 

 

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

 

 

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

 

Personal information on this form is collected under section 38 of New Brunswick’s Right to Information and Protection of Privacy Act (RTIPPA) as it relates to and is necessary for the processing of complaints under the Employment Standards Act and will be used for investigating this complaint. If you have any questions about the collection of this personal information, you may contact the Privacy Officer at AP6050@gnb.ca.