Alabama Department of Industrial Relations

Fraud Report

The Internal Security Division (ISEC) will investigate all reports if evidence is sufficient to proceed. Your identity will be held in strict confidence.
Name of person making complaint/referral:
Address:
City:	State: Zip Code:
Phone Number:	Email Address:
Name of person you are reporting:
Social Security Number:	Occupation:
Home Address:
City:	State: Zip Code:
Phone Number:	D.O.B.: Sex:
Alleged Employer:
Employer Address:
City:	State: Zip Code:
Employer Phone Number:
Work Site (if different from Above):
Work Schedule:
How long has referral been working for alleged employer?
Method of payment:	on payroll off books
Name of previous employer:
Address:
City:	State: Zip Code:
Reason for referral or why fraud is suspected:
	If this matter has been reported to any organizations, please identify the organizations.

Alabama Department Of Industrial Relations
649 Monroe Street, Montgomery, Alabama 36131