Fillable Wage Claim Form printable pdf download

WAGE CLAIM INSTRUCTIONS

PLEASE READ BEFORE COMPLETING FORM

Please Note: There are certain circumstances which may prevent the Arkansas Department of Labor

from pursuing your wage claim. This does not mean your claim is invalid. If your claim should fall into

one of the categories that prevent the Arkansas Department of Labor from working your claim, you may

wish to file with small claims court, or seek the counsel of a private attorney. Remember, Wage Claims are

conducted in an open process and the employer will be allowed to view and respond to your claim

specifically.

1. You may file a claim within three years from the date of the occurrence.

2. This form must be completed in its entirety. Incomplete forms can result in the returning of the

form to you to provide missing information which may results in the delay or possible closing of

your claim. Write N/A for questions that do not apply.

3. Make sure that all address and contact information for the employer is correct. The Department

may not be able to process your claim without the correct mailing and contact information.

4. If you make more than $50,000.00 per year or your claim is more than $2000.00, you are not

eligible to file a wage claim with the Arkansas Department of Labor. If during the investigation it

is discovered that the above amounts are exceeded then your claim will be closed.

5. You may not pursue both a civil action and a wage claim for the wages. You cannot split the

amount owed through our Department and the courts.

6. Claims for vacation, bonuses, sick leave, severance, holiday or shift differential pay, please enclose

any copies of the employer’s handbook or written policies that states how these benefits are to be

paid upon termination or discharge. If your agreement was verbal regarding payment of these

benefits, please provide the names of any witnesses or employees who have similar verbal

agreements to support your claim. Without this type of documentation this type of claim is very

difficult to prove and the Department may not be able to assist you.

7. Please attach any documentation that you think is relevant to your case.

8. Please print clearly and legibly. Forms that cannot be read will be return resulting in additional

delays in processing your claim.

9. It is important that you notify the Department immediately of any changes to your address or

phone number throughout the Wage Claim process. If we cannot contact you during the process

your claim could be closed.

10. If you are filing a claim based on a wage payment in which you received an insufficient check,

attach original check or attach copy of the bank statement indicating the insufficient check.

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Wage Claim Form