Worker Misclassification Inquiry

Department of Labor & Industry

Please provide your contact information.

Required fields are marked with an asterisk.(*)

First Name

Last Name

Phone Type

Phone Number (e.g, XXX-XXX-XXXX)

Business Name

Business Address Line 1

Business Address Line 2

City

State

Zip Code

Business Phone Type

Phone Number (e.g, XXX-XXX-XXXX)

Comments

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