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Please complete this Wage Claim form if you have not been paid for hours worked, have not been paid overtime wages, or if you have had unlawful deductions taken from your paycheck.



Be ready to upload or email the following information when filing your wage claim:

Any evidence, documents or witness statements, and



An explanation or calendar detailing the hours worked for each day of your claim



Failure to submit evidence may result in your wage claim being closed without further action

EXAMPLES OF EVIDENCE: Time Cards, W-2 Statements or Other Tax Forms, Shift Schedules, Employee Handbooks, Attendance Rosters, Written Wage Agreements, Log Books, Statements from Witnesses, Personal Time Records, Employment Job Offer, Payroll Check Stubs, Newspaper Job Advertisement, Copies of Bad Checks, any other evidence that substantiates your employment or rate of pay

We will not accept the following types of wage claims:

Your claim is for penalty wages or expenses only



Your claim is over $15,000 and does not involve minimum wage, overtime, or prevailing wage rate



You were self-employed



You were paid on a commission basis and received at least minimum wage for all hours worked



You were a member of a union or collective bargaining unit (Please contact the agency before filing a claim if you were a union member)



You have already begun private legal action to recover the wages claimed;

None of your work was performed in Oregon;

The claim is against a business in which you were a partner, an owner or had a direct financial interest;

The claim is against a close relative;

The claim is against a person you are unwilling to take to court.

For claims under $50 or claims for benefits only, we will send a letter to the employer. If we are unable to collect with this letter, we will take no further action.





If you have not been paid all wages owed to you upon termination, you may be entitled by law to penalty wages of up to 30 days additional wages. If we are able to collect the amount of unpaid wages owed, then we will not pursue the additional penalty wages. If you want to pursue the penalty wages in addition to unpaid wages owed, do not file a wage claim with the Bureau. You must take private action through an attorney or Small Claims Court.









We are here to help! Please email whdscreener@boli.state.or.us or call 971-673-0761.









