New York State Department of Labor, Division of Labor Standards Complaint Form (LS 223) Completed Form Examples and Samples

My name is Maria Sanchez, and I'm writing this because I really need help getting the wages I'm owed from my last job. I used to work at The Golden Spoon Bistro, located at 456 Elm Street, Suite 101, in the lovely town of Fairhaven, Orange County, NY 10940. Their business phone is (845) 555-1234, and I think the owner, Mr. David Lee, has an email at [email protected], though I'm not entirely sure. He’s the main guy who hired me and paid my wages. The bistro is a busy place, a restaurant, obviously, and I'd estimate they have about 18 employees. I’m pretty sure it’s registered as an LLC. I believe they're still in business, at least they were when I last checked. My bank never had any issues with my checks, so I don't know about their bank details or bankruptcy. 

I started there as a line cook on March 15, 2024. Mr. Lee himself handled my hiring. My main job was preparing meals, especially during dinner rushes. Initially, I was promised $16 per hour, which was paid weekly, usually on Fridays, covering the previous Saturday through Friday. However, after about a month, without much explanation, my paychecks started reflecting $14 per hour, effective April 15, 2024. I regularly worked more than 40 hours a week, often clocking in 50-55 hours, but I was never paid time and a half for overtime. In fact, for the last three full weeks of my employment, from July 13th to August 2nd, 2024, I worked 52, 50, and 54 hours respectively, but was only paid at the $14 regular rate for 40 hours each week. This means I was significantly underpaid and not compensated for the additional hours or overtime. I was discharged on August 2, 2024, supposedly due to 'staff restructuring', but I suspect it was because I started asking about my pay discrepancies. I asked Mr. Lee directly about the pay on July 29th, and he just brushed me off, saying 'we'll look into it.' Nothing came of it. My typical workday started at 1 PM and ended at 11 PM.

Another thing: I was required to wear a chef's jacket and black pants. I had to buy my own jackets, which cost about $35 each, and I needed two, so $70 total. They weren't provided for free. Also, during my shifts, which often ran 10 hours or more, I rarely got a full 30-minute meal break. Sometimes I got 15 minutes, sometimes nothing at all, and I was always on the clock during those times. I don't recall ever seeing any official wage rate notices or minimum wage posters prominently displayed, and I definitely didn't get proper pay stubs that clearly broke down my hours and pay. My primary language is Spanish, but I can communicate well in English. My address is 123 Maple Drive, Apt 2B, Springfield, Dutchess County, NY 12578. My phone is (914) 777-8888, and my email is [email protected]. My friend, Elena, helped me type this out because my English isn't perfect, but she didn't advise me on the legal aspects. I haven't filed any lawsuits or gone to small claims court yet.