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 read and follow the

instructions below:

•

must have asked your employer for the wages you

In order to receive the full benefits due to you under Oklahoma law, 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.

causing a delay in processing your claim. You can

• This claim form must be signed and notarized or it will be returned to you

take your claim to either the Tulsa or Oklahoma City office of the Oklahoma Department of Labor for notarization but it will not be

accepted through the mail if not notarized.

• Your employer will be notified via U.S. mail of your complaint within ten (10) working days of the date your claim is received by

ODOL. 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, pay stubs, etc.) if available to avoid any delays in processing time.

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

______________________________________________________________________________________

ALWAYS BE REACHED:

PERSON THROUGH WHOM YOU CAN

NAME

HOME TELEPHONE

RELATIONSHIP

________________________________________________________________________________________________

I HEREBY CERTIFY, that this is a true statement of wages due to me to the best of my knowledge and belief. I understand that falsification of

any information required by this form is a felony and can result in criminal prosecution. I understand acceptance of this claim by the

Oklahoma Department of Labor does not guarantee collection.

_____________________

______________________________________________

Date

Claimant's Signature

Subscribed and sworn / affirmed before me this ______ day of ________________, 20____.

My commission expires: ______ / ______ / ______

_______________________________________

Notary Public

(Seal)

Wage Claim Form Page 2