Wage Claim

WAGE CLAIM

Instructions for Filing a Wage Claim Form 

If you have experienced wage theft you can file a wage claim with the Oklahoma Department of Labor (ODOL).  Workers in Oklahoma have the right to file a wage claim when their employer does not pay them the wages they are owed.  A wage claim starts the process to collect unpaid wages.  ODOL serves as an advocate for Oklahoma’s workforce. ODOL labor compliance officers investigate the validity of wage claims and, if warranted, will issue orders demanding payment on behalf of employees. For more information about Oklahoma wage laws, access the ODOL website at www.ok.gov/labor.
Please read and follow the instructions below:
To assist the ODOL in processing your claim and to expedite our investigation, it is helpful if you have first asked your employer for the wages you believe are due you before completing and filing this form with ODOL.
This form must be filled in completely. Be thorough when explaining your claim including all dates related to your claim.
This claim form must be signed or it will be returned to you, causing a delay in processing your claim. You can personally return or mail your completed claim form to the office of the Oklahoma Department of Labor (409 NE 28th St, 3rd Floor, Oklahoma City, OK 73105).
Your employer will be notified via Priority Mail of your complaint and must respond in writing to your investigating officer within 15 calendar days of receipt of the claim. This response period may be extended by your investigative officer for good cause. 
Please make every effort to provide a valid mailing address for the business you are filing your claim against in order to ensure timely processing of your claim. • 
Attach any documents (i.e. time sheets, company policy, prior pay stubs, etc.) if available to avoid any delays in processing time.

Claimant Information
First Name
This question is required
Last Name
This question is required
Address
Street*
City/Suburb
State*
Zip/Post Code*
Country*
This question is required
Phone Number
Email
Age
Gender
Female
Male
Prefer Not to Answer
Alternate or additional address
Street
City/Suburb
State
Zip/Post Code
Country
Employer Information
Employer/Business Name?
This question is required
Owner/Manager Name?
Business Mailing Address
Street*
City/Suburb
State*
Zip/Post Code*
Country*
This question is required
Business Phone Number
Type of Business
Address Where Work Performed
Street
City/Suburb
State
Zip/Post Code
Country
Employment Information
Describe Work Performed
Date(s) of Employment
Start Date
/
/
End Date
/
/
Presently employed
Yes
No

Are you an independent contractor?
Yes
No
Have you asked for your wages?
Yes
No
Are you a member of a union?
Yes
No
Do you have any of the employer's property?
Yes
No
Do you owe the employer any money?
Yes
No
Is the business still open and operating
Yes
No
Has the business filed for bankruptcy?
Yes
No
Type of Employment Agreement?
If written, do you have a copy?
Oral
Written
If written, do you have a copy?
Rate of Pay
Hourly
Salaried
Commission
Other
What was your agreed rate of pay?
This question is required
Rate of Pay
Hourly, weekly, bi-monthly, monthly, yearly, per unit
Select...
This question is required
Hourly, weekly, bi-monthly, monthly, yearly, per unit
What were your scheduled paydays?
Select...
Were regular working hours set by the employer?
Yes
No
Did your employer provide a pay stub showing deductions with each payment of wages?
Yes
No
Were taxes withheld from your paycheck?
Yes
No
Did you authorize deductions other than taxes?
If yes, what deductions?
Yes
No
If yes, what deductions?
If yes, what authorized deductions did you authorize?
Reason given by employer for non-payment of wages?
Upload supporting documents
Choose a file
Total Unpaid Wages Claimed
Regular Wages?
Commission
Minimum Wage ($7.25)
Benefit(s)
Vacation, Bonus, Holiday Pay, Etc.
Vacation, Bonus, Holiday Pay, Etc.
Unauthorized Deductions
Overtime Pay
Miscellaneous
TOTAL
Claim cannot be pursued without a dollar amount claimed listed.
0
Claim cannot be pursued without a dollar amount claimed listed.
Please explain how you arrived at the dollar amount claimed.
Please list the date and amount of unpaid wages claimed.
Date
/
/
Amount
Date
/
/
Amount
Date
/
/
Amount
Date
/
/
Amount
Date
/
/
Amount
Date
/
/
Amount
To add more dates/amounts, list here the date and amount of unpaid wages claimed.
In accordance with 12 O.S. §426, 1  state under penalty of perjury, under the laws of the State of Oklahoma that the foregoing wage claim is true and
correct.
Date
/
/
City
County
Signature
Sign here
  
This question is required
Submit

12 O.S. §426 Whenever, under any law of Oklahoma or under any rule, order, or requirement made pursuant to the law of Oklahoma, any matter is
required or permitted to be supported, evidenced, established, or proved by the sworn statement, declaration, verification, certificate, oath, or affidavit, in
writing of the person making the same (other than a deposition, or any oath of office, or an oath required to be taken before a specified official other than
a notary public), the matter may with like force and effect be supported, evidenced, established, or proved by the unsworn statement in writing of the
person made and signed under penalty of perjury setting forth the date and place of execution and that it is made under the laws of Oklahoma . . . The
signed statement under penalty of perjury shall constitute a legally binding assertion that the contents of the statement to which it refers are true.