New & Improved Wage Claim Form

Beginning July 6, 2012, the Labor Commissioner is pleased to begin using a new and improved wage claim form (Form 1, “Initial Report or Claim”) to aid workers seeking to recover unpaid wages and other compensation. In addition to the claim form, two new information sheets are available to assist claimants with filing wage claims. 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 claimants need some assistance in filling out the claim form, the “Guide to Completing Initial Report or Claim Form” provides some basic information about each question on the Form 1.
The new Form 1 and information sheets are available in English, Spanish, Chinese, Korean, Tagalog, Vietnamese and Punjabi and may be accessed through this link: http://www.dir.ca.gov/dlse/HowToFileWageClaim.htm

The Department of Industrial Relations (DIR) recognizes the importance of communicating effectively with individuals, including those with limited English proficiency. DIR is making an effort to provide meaningful services for individuals that speak languages other than English.

If you need to access information in a language other than English:

Use the Google Translate function below:

Note: This is a service provided by Google. Google Translate cannot translate all types of documents, and may not provide an exact translation.

Contact DIR to request an interpreter over the phone:

Office Name	Topic	Phone Numbers
Cal/OSHA	Workplace Safety and Health	833-579-0927
Labor Commissioner's Office	Wages, breaks, retaliation and labor laws	833-526-4636
Division of Workers' Compensation	Benefits for work-related injuries and illnesses	1-800-736-7401
Office of the Director	Any other topic related to the Department of Industrial Relations	844-522-6734

New & Improved Wage Claim Form

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