This document is an employment wage complaint filed by Adalberto Cervantes Rodriguez with the Michigan Department of Licensing and Regulatory Affairs against his former employer, the Mexican Consulate in San Antonio, Texas. Mr. Rodriguez claims he is owed $22,000 in unpaid wages for the period of March 15, 2015 to January 1, 2011. He worked as a consular official and claims the unpaid amount is for hourly wages and overtime pay.

1. EMPLOYMENT WAGE COMPLAINT
Michigan Department of Licensing and Regulatory Affairs
Michigan Occupational Safety and Health Administration
Wage & Hour Division
IMPORTANT: By filing this claim with the Wage and Hour
Division, you are electing a remedy which may prevent you
from pursuing this claim elsewhere, including civil court.
EMPLOYEE INFORMATION Please print
Cervantes Rodriguez, Adalberto
ADDRESS (STREET NUMBER AND NAME):
5414 Lancashire Drive
CITY, STATE, ZIP:
San Antonio, TX 78230
COUNTY:
Bexar County
BIRTH DATE:
02/18/1963
3744
San Antonio Down Town
San Antonio TX 78230
adalberto_cervantes@hotmail.co 210-807-3316
EMPLOYER INFORMATION
Mexican Consulate at San Antonio, TX
San Antonio Dowtown
CITY, STATE, ZIP:
San Antonio, TX 78230
EMAIL OR WEBSITE ADDRESS OF EMPLOYER (IF KNOWN):TELEPHONE NUMBER:
LIST THE APPROXIMATE NUMBER OF EMPLOYEES:NAME OF PERSON IN CHARGE OF DAY-TO-DAY OPERATIONS:
01/01/2011Start date of employment (Month/Day/Year): 03/15/2015
Employment Status:
X
LIST YOUR RATE OF PAY: PER HOUR
$
SALARY PIECE RATE/OTHER
How often were you paid?
MONTHLY
LAST 4 NUMBERS OF SOCIAL SECURITY
NUMBER:
LAST NAME, FIRST NAME, MIDDLE INITIAL
EMAIL ADDRESS: PRIMARY TELEPHONE NUMBER: DAYTIME TELEPHONE NUMBER:
ADDRESS WHERE YOU WORKED (STREET NUMBER AND NAME):
CITY, STATE, ZIP: COUNTY:
AUTHORITY: ACT 390, PUBLIC ACTS OF 1978, AS AMENDED
ACT 154, PUBLIC ACTS OF 1964, AS AMENDED
COMPLETION: VOLUNTARY
PENALTY: NONE
BUSINESS NAME:
BUSINESS ADDRESS (STREET NUMBER AND NAME):
COUNTY
Last date worked (Month/Day/Year):
QUIT DISCHARGED STILL EMPLOYED
COMMISSION
$ $$
If salaried, how many days/hours were you required
to work each week or pay period?
WEEKLY SEMI-MONTHLYBI-WEEKLY X
220000
40
Bexar County
bexar County
X Mr. Ms. Mrs. Miss. Dr.
PROVIDE A COPY OF YOUR CHECK STUB.
What was/is your job title?
Was Your Employment Governed by One or More Employers? If so, list below the additional employer's name, address, city,
state, zip code, and telephone number or attach an addiitional sheet listing the information.
Mailing Address:
P.O. Box 30476
Lansing, MI 48909-7976
Street Address:
7150 Harris Drive
Dimondale, MI 48821
Website: www.michigan.gov/wagehour
LARA is an equal opportunity employer/program. Auxilliary aids,
services and other reasonable accommodations are available,
upon request, to individuals with disabilities for the purpose of
accessibility under the state and federal law. Please call
CLAIM NUMBER:
Telephone: 517.322.1825 Facsimile: 517.322.6352
517.322.1825 to make your needs known to this agency.
CONTACT INFORMATION FOR SOMEONE WHO WILL ALWAYS KNOW HOW TO REACH YOU.
Elizabethe Cervantes-Wife
TYPE OF BUSINESS:
92 Public Administration - Federal, State,
FAX NUMBER:

2. 220000
THE CLAIM WILL BE RETURNED IF A CLAIM AMOUNT AND A CLAIM PERIOD ARE NOT PROVIDED.
Your Reason for
Filing this Claim
Amount
Claimed
Period Claimed Calculate Amount Claimed
(Attach additional sheets if necessary)Month/Day/Year Month/Day/Year
Hourly Wages
Salary
Commissions
Unauthorized
MINIMUM WAGE
Vacation Pay
Sick Pay
Expense
Holiday Pay
Paid Time Off
Bonus
Piece Rate/Other
TOTAL GROSS (before tax deductions) AMOUNT CLAIMED
to
2200003/15/2015
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220000
Filing this complaint does not guarantee payment or a finding in your favor.
(Provide list of commissions)
Deductions
Reimbursement
(Provide list of expenses)
OVERTIME
(List type of bonus)
FRINGE BENEFITS
(Provide written policy or contract)
WAGES
Please provide documentation to substantiate your claim, for example, pay stubs, time sheets, written policies and ect.
1/1/2011

3. If claiming fringe benefits, was a written policy or contract in effect during your employment?
If yes, please provide a copy of the written policy or contract.
Was your employment covered by a union contract? If yes, please submit a copy of the contract.
PLEASE ANSWER THE FOLLOWING
Does the business make more than $500,000/year or transport goods outside of Michigan?
YES NO
X
CERTIFICATION:I certify that to the best of my knowledge and belief, this is a true statement of wages and/or fringe benefits due me. I will
inform the department if any of the following occur: Change of name, address, and/or telephone number for myself and/or employer, or a direct
ONLINE REFERENCE NUMBER: DATE: 03/15/2015210-807-3316
ADDITIONAL INFORMATION THAT PERTAINS TO YOUR COMPLAINT WILL BE SENT VIA EMAIL.
X
X
Have you filed a law suit against the employer on the issues of this claim? X
Signature of Complainant: DATE:
payment or settlement of the claim.
Are you filing a complaint for pay stubs or wage statements you did not receive?
XIf yes, please list dates you did not receive a pay stub or wage statement
Yes, my pension, for IMSS pension for labor risk insurance
coverage working for Infosys technologies in Mexico
YES NO