Report Unauthorized Alien Workers

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If you have information that a business entity is violating the law by employing unauthorized alien(S), please complete this form and submit.

Report Unauthorized Alien Workers

Company

This field is for validation purposes and should be left unchanged.

YOUR CONTACT INFORMATION

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

County

Primary Phone Number(Required)

Email(Required)

Please select one box:(Required)

I am a state official.

I am a resident of the State of Missouri.

I am the registered agent, corporate officer or legal representative of a business entity.

Business Information

(Information about the business entity you believe has hired unauthorized workers.)

Business Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County

Business Phone Number

Website

Name of Owner or Principal

Type of Business

Complaint Information

A valid complaint cannot allege a violation solely or primarily based on national origin, ethnicity or race.

Describe in detail the information that indicates the business employs unauthorized aliens.(Required)

Specifically describe each individual you believe to be an unauthorized alien worker. Relevant information may include a person’s name, alias, nickname, work title, job description, length of employment, etc. A valid complaint should provide enough information for the business entity to reasonably identify the individual(s) alleged to be an unauthorized worker(s).

Dates the business employed unauthorized aliens?(Required)

Describe the location where the business employed unauthorized aliens?

If known, what state administered the tax credit, abatement or loan being received by the business?

Section 285.530 of the Revised Statutes of Missouri prohibits businesses entities or employers who receive state administered tax credits, abatements or loans, as well as those awarded contracts or grants from the State of Missouri in excess of $5000, from knowingly employing, hiring for employment, or continuing to employ an unauthorized alien to perform work in Missouri. Section 285.535 allows any state official, business entity or state resident to file a complaint regarding the employment of unauthorized aliens. Providing false information in this affidavit can result in civil and/or criminal penalties. I DECLARE UNDER PENALTY OF PERJURY under the laws of the State of Missouri that the foregoing is true and correct to the best of my knowledge and belief. If signing for a business entity in a representative capacity, I acknowledge that I am authorized to sign this application on behalf of the complainant.