Fillable Wage Claim Form (Page 2 of 2) in pdf

Instructions for Filing a Wage Claim Form

The Oklahoma Department of Labor (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

Please read and follow the instructions below:



To assist the ODOL process your claim and to expedite our investigation, you must have 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. Your electronic

(typed) signature on this form is sufficient if submitting by email. You can personally return or mail your completed claim

form and any supporting documents to the office of the Oklahoma Department of Labor (3017 N Stiles Ave, Ste 100 Oklahoma

City, OK 73105); fax your completed claim form and any supporting documents to 405-521-6017; or email your completed claim

form and any supporting documents to wageclaims@labor.ok.gov.



EMAIL PROCESS: After completing this form click on the “Submit” in the upper-right corner of the first page, it should

automatically load into your email program to be mailed to the Oklahoma Department of Labor. Supporting documents

should be attached as PDF documents only. If you are unable to convert your supporting documents into PDF format,

or if the amount of supporting documents are too large for your email provider, you may submit them by hand-delivery,

mail, or fax. IF SENDING SUPPORTING DOCUMENTS SEPARATE FROM YOUR EMAILED CLAIM PLEASE CLICK THE

APPROPRIATE TAB.

ADDITIONAL DOCUMENTS WILL BE SUBMITTED (Please check any that apply):

☐ PERSONALLY

☐ BY MAIL

☐ BY FAX



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. We

must have a valid mailing address for the business you are filing your claim against in order to process your claim.



Attach any documents (i.e. time sheets, company policy, prior pay stubs, etc.) if available to avoid any delays in processing time.

USE THIS SPACE FOR FURTHER DETAIL IF NECESSARY, OR ATTACH ADDITIONAL INFORMATION:

PERSON THROUGH WHOM YOU CAN ALWAYS BE REACHED:

NAME:

TELEPHONE:

RELATIONSHIP:

In accordance with 12 O.S. §426,

I state, under penalty of perjury, under the laws of the State of Oklahoma that the foregoing wage claim is true and

correct.

Date: ____________________________

County & City where signed: _________________________________________

Signature: __________________________________________________

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.

Wage Claim Form Page 2

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