Complaint about your working conditions

Your personal information

Prénom*

Nom*

N° civique, rue et n° d’appartement*

Ville*

Province*

Code postal*

Téléphone*

Courriel*

N° de carte de compétence

Date de naissance*

Date

of

Birth

Information on your employment

Practised Trade*

Date d'embauche (approximative)*

Date de départ

Nom de l'entreprise*

N° et rue*

Ville*

Province*

Code postal*

Téléphone

Additional information

Hourly wage*

Mandatory uniform*

Paid by the employer
Paid by me
No uniform

Pay mode*

Cash
Cheque
Direct deposit

Pay frequency

Weekly
Bi-weekly

Pay slip

Detailed slip
Pay envelope

Attendance control

Punch
Manual
No control

Reason for complaint

Choose reason*

Unpaid overtime
Unpaid hours
Unpaid holiday (Specify in the description section below.)
No prior departure notice or indemnity
No vacation or vacation indemnity
Insufficient hourly wage
Other (Specify in the description section below.)

Description

Veuillez détailler et joindre les pièces justificatives s'il y a lieu*

If you need to transmit file, please upload them here

Drop files here or

Accepted file types: jpg, png, pdf, docx, xlsx, Max. file size: 54 MB.

Did you upload any supporting documents ?*

Yes
No

Signature

I request that CPA Montréal investigates and claims, if applicable, all amounts due to me.

I agree to inform CPA Montréal of any changes to my situation or my personnal information.

I agree to inform my employer about my request*

Yes
No

Confirmation*

By checking this box, I confirm that the information provided herein is accurate and can be used as my signature.

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