H-1B Nonimmigrant
U.S. Department of Labor
ESA Form WH-4
Information Form
Employment Standards Administration
OMB Approval: 1205-0310
Expiration Date: 11/30/2003
This report is authorized by 8 U.S.C. 1182(n)(2)(G)(ii) of the American Competitiveness and Workforce
Improvement Act (ACWIA) of 1998. The information provided on this form will assist the Department
of Labor in determining whether the named employer of H-1B nonimmigrants has committed a violation
of provisions of the H-1B program. Your identity will be kept confidential to the fullest extent provided
by law. Please provide as much of the requested information as possible. Attach additional sheets if
you need additional space to respond to a question. If you do not understand a term, or need
assistance in the completion of this form, please contact the local Wage and Hour office of the U.S.
Department of Labor. After you submit the form, a representative from the Department of Labor may
contact you if further information is necessary to initiate an investigation.
1. Person Submitting Information (please print)
Mr., Miss, Mrs., Ms.
First Name
Middle Initial
Last Name
Current Address:
Number, Street, Apt, or P.O. Box No.
City, State, ZIP Code
Telephone Number: (including area code)
Days/Times When You Can be Reached at that Number:
E-Mail Address (optional):
2. Nature of Source's Relationship to Employer; (Please check all that apply)
(a)
H-1B Nonimmigrant Employee
Former or
Current Employee (dates of employment):
(b)
U.S. Worker
Former or
Current Employee (dates of employment):
(c)
(d)
(e)
(f)
(g)
(h)
Job Applicant (date of application):
Competitor Business (please specify):
Federal Government Agency (please specify):
State or Local Government Agency (please specify):
Community or Service Organization (please specify):
Other (please specify):
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3.
Information on H-1B Employer Committing Alleged Violation

Name of Employer/Company:
Address:
Number, Street
City
State
ZIP Code
Employer Representative to be Contacted:
Telephone Number (including area code):
4. Description of Alleged H-1B Violations
Please check the appropriate box(es), (a) through (q), which best describe the violation of the H-1B

provisions of the Immigration and Nationality Act which you believe have occurred. In section 8,

identify each item checked and describe, in as much detail as possible, the facts and circumstances

which cause you to believe that violations have occurred.
(a)
Employer supplied incorrect or false information on the Labor Certification Application (LCA).
(b)
Employer failed to pay H-1B worker(s) the higher of the prevailing or actual wage.
(c)
lack of work) or for time needed by the H-1B worker(s) to acquire a license or permit.

Employer failed to pay H-1B worker(s) for time off due to a decision by the employer (e.g., for
(d)
processing; for food and housing expenses while the worker Is traveling on employer's business; for

tools and equipment necessary to perform employer's work).
Employer made illegal deductions from H-1B worker's wages (e.g., for H-1B petition
(e)
U.S. worker(s) (e.g., cash bonuses, stock options, paid vacations and holidays, health benefits,

insurance, retirement and savings plans).
Employer failed to provide fringe benefits to H-1B worker(s) equivalent to those provided to
(f)
on the same basis as it does U.S. worker(s), or the employment of H-1B worker(s) adversely affects

the working conditions of U.S. worker(s).
Employer does not afford H-1B worker(s) working conditions (hours, shifts, vacation periods)
(g)
out H-1B worker(s) during the validity period of the LCA to any place of employment where there is a

labor dispute; 2) failing to notify the DOL, within 3 working days of the occurrence, of such a labor

dispute; or 3) using an LCA for H-1B worker(s) to work at a site before the DOL has determined that a

labor dispute has ended.
Employer failed to comply with "no strike/lockout" requirement by: 1) placing or contracting
(h)
hard copy posting or electronically, notice of its intentions to hire H-1B worker(s), or has failed to

provide H-1B worker(s) with a copy of the LCA.
Employer failed to provide employees or their collective bargaining representative, either by
(i)
Employer required H-1B worker(s) to pay all or any part of $500/$1000 filing fee.
(j)
employer prior to a date agreed upon by the worker and employer.
Employer imposed an illegal penalty on H-1B worker(s) for ceasing employment with the
(k)
for disclosing information, fling a complaint, or cooperating in an investigation or proceeding about a

violation of the H-1B laws and regulations (i.e., whistleblower).
Employer retaliated or discriminated against an employee, former employee, or job applicant
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(l)
necessary documents at the employer's principal place of business or worksite.
Employer failed to maintain and make available for public examination the LCA and
(m)
1B worker(s) within 90 days before or after filing H-1B visa petitions.
Employer laid off U.S. worker(s) and has replaced or seeks to replace U.S. worker(s) with H­
(n)
been laid off, and/or has failed to inquire of the second employer whether it has or intends to lay-off

U.S. worker(s) and replace them with H-1B worker(s).
Employer placed H-1B worker(s) at another employer's worksite where U.S. workers have
(o)
Employer failed to recruit U.S. worker(s) for jobs for which H-1B worker(s) are sought.
(p)
job for which the H-1B worker was sought. Complaints regarding this violation should be filed with the

U.S. Department of Justice, 10th and Constitution Ave., N.W., Washington, D.C., 20530.
Employer failed to hire a U.S. worker who applied and was equally or better qualified for the
(q)
Other
5. Date(s) of Alleged Violation(s):
6. Location of Worksite(s) where Alleged Violation(s) occurred:
7. Basis of Knowledge of Alleged Violation(s):
8. Description of facts and circumstances which support allegations in items 4 (a) through (q). Use
additional sheets of paper, if necessary.
FOR DOL USE ONLY
Complaint Received/Taken by:
Date:
Source of Complaint is:
Aggrieved Party
Credible information source
Public Burden Statement: We estimate it will take an average of 20 minutes to complete this form, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, send them to the U.S. Department of Labor, Wage and
Hour Division, Room S-3502. 200 Constitution Avenue, N.W., Washington, D.C. 20210.
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