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How to file a wage claim

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What is a wage claim?


An employee or former employee may file an INDIVIDUAL wage claim to recover:

  • Unpaid wages, including overtime, commissions and bonuses.
  • Wages paid by check issued with insufficient funds.
  • Final paycheck not received.
  • Unused vacation hours that were not paid upon termination of the employment relationship, e.g., a quit, discharge, or layoff.
  • Unauthorized deductions from paychecks.
  • Unpaid/non-reimbursed business expenses.
  • Reporting time pay/split shift premiums.
  • Failure to provide a meal and/or rest period in accordance with the applicable Industrial Welfare Commission Order.
  • Liquidated damages for failure to receive minimum wage for each hour worked.
  • Waiting time penalties for failure to receive final wages timely upon separation of employment.
  • Penalties for paycheck(s) not negotiable within 30 days of receipt.
  • Penalties for employer’s failure to allow inspection or copying of payroll records within 21 days of request.

What are the policies and procedures for processing a wage claim?


Click here to download a pamphlet that describes the policies and procedures for processing a wage claim.


How do I file a wage claim?

***NEW CLAIM FORM as of July 2012***

Download, complete, and print the Initial Report or Claim, DLSE Form 1 (Revised 07/2012). The Form 1 claim form is accompanied by two information sheets to assist claimants.  The “Instructions for Filing a Wage Claim” explain which documents and forms should be submitted by claimants in order to file a wage claim.  If you need assistance in filling out the Form 1, the “Guide to Completing Initial Report or Claim Form” is a question-by-question guide that presents some basic information about each question on the claim form.

** PLEASE DESCRIBE THIS IMAGE ** English Form 1          ** PLEASE DESCRIBE THIS IMAGE ** English Instructions & Guide
** PLEASE DESCRIBE THIS IMAGE ** Spanish Form 1
Reporte Inicial o Reclamo
** PLEASE DESCRIBE THIS IMAGE ** Spanish Instructions & Guide
Instrucciones Para Llenar Un Reclamo De Salario>
Guía Para Completar El “Reporte Inicial O Reclamo” (Forma DLSE 1)
** PLEASE DESCRIBE THIS IMAGE ** Chinese Form 1
初次報告或索償
** PLEASE DESCRIBE THIS IMAGE ** Chinese Instructions & Guide
工資索償說明
“初次報告或索償” 表格完成指南 (DLSE 表格 1)
** PLEASE DESCRIBE THIS IMAGE ** Korean Form 1
초기 보고서 밎 청구
** PLEASE DESCRIBE THIS IMAGE ** Korean  Instructions & Guide
임금청구 제기 설명서
"초기 보고서 또는 청구"양식(DLSE 1 양식서)  완료 안내서
** PLEASE DESCRIBE THIS IMAGE ** Vietnamese Form 1
Khiếu nại hoặc Báo cáo Bước đầu
** PLEASE DESCRIBE THIS IMAGE ** Vietnamese Instructions & Guide
HƯỚNG DẪN NỘP ĐƠN KHIẾU NẠI TIỀN LƯƠNG
Hướng dẫn Điền Đơn “Khiếu nại hoặc Báo cáo Bước đầu”(DLSE Form 1)
** PLEASE DESCRIBE THIS IMAGE ** Tagalog Form 1
Inisyal na Ulat o Paghahabol
** PLEASE DESCRIBE THIS IMAGE ** Tagalog Instructions & Guide
Mga Instruksiyon Para Sa Pagsasampa Ng Isang Paghahabol Ng Sahod
Gabay sa Pagkumpleto ng Form para sa “Inisyal na Ulat o Paghahabol” (DLSE Form 1)
** PLEASE DESCRIBE THIS IMAGE ** Punjabi Form 1
ਸ਼ੁਰੂਆਤੀ ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ
** PLEASE DESCRIBE THIS IMAGE ** Punjabi Instructions & Guide
ਮਜ਼ਦੂਰੀ ਦਾ ਦਾਅਵਾ ਭਰਨ ਵਾਸਤੇ ਹਿਦਾਇਤਾਂ
“ਸ਼ੁਰੂਆਤੀ ਰਿਪੋਰਟ ਜਾਂ ਦਾਅਵਾ” ਫਾਰਮ (DLSE ਫਾਰਮ 1) ਭਰਨ ਲਈ ਗਾਈਡ
  • Please be sure to provide all information on the claim form to avoid delay in the claim process.
  • Please be sure to sign and date your claim form.

What other DLSE forms must be submitted with my Initial Report or Claim (DLSE 1)?


IMPORTANT: Along with your completed “Initial Report or Claim” form (Form 1), submit these additional DLSE forms if any of the following situations apply to you:

  • DLSE Form 55 for claimants who worked irregular hours:  If your work hours and/or days of work varied per week or were irregular and you are claiming unpaid wages (for non-overtime or overtime hours worked) or meal and rest period violations, then also fill out and submit the DLSE Form 55.
  • DLSE Form 155 for claimants with commission claims:  If you are claiming commission pay, then also fill out and submit the DLSE Form 155.
  • DLSE Vacation Pay Schedule for claimants seeking vacation wages:  If you are claiming vacation wages, then also fill out and submit the DLSE Vacation Pay Schedule form.
    • Download, print and complete the DLSE Vacation Pay Schedule (** PLEASE DESCRIBE THIS IMAGE ** Pdf). See Sample Vacation Pay Schedule (** PLEASE DESCRIBE THIS IMAGE ** Pdf).
    • Instructions (Recapitulation of Vacation Pay)/ Instrucciones (Recapitulación de Pago de Vacacione): ** PLEASE DESCRIBE THIS IMAGE ** Pdf
  • Claimants who are represented: If you are represented by an attorney or other advocate, you may submit a calculation prepared by your attorney or advocate instead of the DLSE Form 55, DLSE Form 155, or DLSE Vacation Pay Schedule required above.

What supporting documents should I submit with my Initial Report or Claim (DLSE 1)?

IMPORTANT:  Along with your completed “Initial Report or Claim” form (Form 1), submit one copy of the following documents, if you have them (DO NOT SUBMIT ORIGINAL DOCUMENTS):

  • Time records.  Provide a COPY of any records you kept of the hours and dates you worked that support your claim.
  • Paychecks and pay stubs.  Provide a COPY of any paychecks and pay stubs you received showing the wages you were paid during your claim period.
  • Dishonored (or “bounced”) paycheck(s).  If you were paid with a paycheck that could not be cashed by you because your employer has no account with the bank or insufficient funds in the account from which the check was drawn, provide a COPY of any such dishonored check(s) or other documentation from the bank that indicates the check could not be cashed.
  • Notice of employment information.  Provide a COPY if you received a notice from your employer after January 1, 2012 that indicates your basic employment information including your rate of pay, any overtime rate of pay, whether you were paid by the hour, shift, day, week, salary, piece, commission, or otherwise, and your regular payday.

    NOTE:  It is the employer’s legal responsibility to keep accurate employee time and payroll records, and to provide employees with itemized wage statements each time they are paid (or at least semimonthly).  In order to file a claim, you are not required to keep your own time records or to have the documents above.  These documents are being requested only if you have them because they may help DLSE better understand your claim.
  • Collective Bargaining Agreement.  If your employment was covered by a union contract, provide a COPY of the Collective Bargaining Agreement.

Where do I file my wage claim?


File your claim either by mail or in person with the Division of Labor Standards Enforcement (DLSE) office that handles wage claims for the city/location/community where you performed the work. To locate such office, click here for an alphabetical listing of cities/locations/communities.

The claim form CANNOT be filed electronically or by fax. If your internet browser supports email of pages, DO NOT use this feature to submit your claim form as an original signature is required. You MUST print and either mail or hand-deliver a copy of your claim form to the DLSE office that handles wage claims for the city/location/community where you performed the work.

** PLEASE DESCRIBE THIS IMAGE **If you do not already have Adobe Acrobat installed on your computer, you should download the free Acrobat Reader from Adobe's web site at www.adobe.com, download instructions are available on the Adobe web site. Once you have downloaded the Acrobat Reader you can view PDF documents in your web browser if it supports plug-ins, or if it does not support plug-ins, you can save the file(s) to your hard drive and view them by opening them in Acrobat Reader.