Appendix 2: Template Request for a Statement of Interest from Labor or Employment
Agency
[AGENCY NAME AND ADDRESS]
XXX 202X
Re: Request for Statement of Interest
[Case Name] [Case/Inspection Number]
To Whom It May Concern:
I write as attorney for [CLIENT], worker complainant(s) and/or witness(es) in [CASE NAME],
[CASE NUMBER] before [AGENCY]. We write to request [AGENCY] submit a Statement of
Interest to support worker victims and witnesses in this case who may wish to apply to the
Department of Homeland Security for prosecutorial discretion, including, but not limited to,
deferred action or parole, and work authorization.
[DESCRIBE LEGAL BASIS OF COMPLAINT, CURRENT STATUS, AND CLIENT
PARTICIPATION. E.g., CASE NAME alleges violations of the minimum wage and overtime
provisions of the Fair Labor Standards Act. The case is currently pending before the Houston
District Office of the Department of Labor’s Wage and Hour Division.]
[DESCRIBE STAKES of potential or actual retaliation on the labor investigation. E.g. Fear of
immigration retaliation has made numerous workers, including CLIENT, reluctant to participate
in DOL’s investigation. Workers’ fear is particularly acute in this case because their employer
explicitly threatened to report several workers to immigration earlier this month after a meeting
at the workplace during which workers complained about ongoing wage theft and other labor law
violations. A history of worksite immigration raids in the region has further contributed to a
pervasive chilling effect that is deterring worker cooperation in the ongoing DOL investigation.]
Therefore, we request [AGENCY] issue a Statement of Interest in this case to support individual
applications for deferred action and/or parole, and work authorization, from workers to facilitate
[AGENCY]’s [pending investigation, litigation, or enforcement interests] and to counteract the
chilling effect on labor disputes caused by the fear of immigration-based retaliation, consistent
with the criteria in [DOL or other agency’s]’s guidance on this process. [“Process for Requesting
Department of Labor Support for Requests to the Department of Homeland Security for
Immigration-Related Prosecutorial Discretion During Labor Disputes,” Department of Labor
(July 6, 2022), available at https://www.dol.gov/sites/dolgov/files/OASP/files/Process-For-
Requesting-Department-Of-Labor-Support-FAQ.pdf].
We request the Statement of Interest include all workers employed by [EMPLOYER] at
[WORKSITE(S)] at any time from [DATES RELEVANT TO LABOR DISPUTE], as these
workers are all potential victims and witnesses in [CASE NAME] during the pendency of the
agency’s investigation and litigation, or during the period of any enforceable judicial order or
decree, including any period of compliance and monitoring.