Downloadable Claim Forms
Directions for Filing the Initial Claim for Unpaid Wages
U.S. Postal mail only. Faxed forms cannot be accepted!
If you are claiming pay for work performed, please print out and submit your completed claim form to the following address by U.S. Mail:
Division of Labor and Employment Law
Virginia Department of Labor and Industry
600 East Main Street, Ste. 207
Richmond, Virginia 23219.
Remember to sign the claim form and make sure to include the employer’s full address as well the total amount of wages claimed.
Please include your email address for notices about your claim.
Reminder: Faxed or emailed forms cannot be accepted.
IMPORTANT OVERTIME UPDATE: As of 07/01/22, and pursuant to VA Code § 40.1-29.2, Individuals who feel that they are owed overtime wages under the Virginia Overtime Wage Act should direct their inquiries and complaints to the United States Department of Labor or pursue private litigation.
Claim for Unpaid Wages Form – English
Complete this claim form if you have not properly been paid your wages owed to you by your employer or are not being paid the Virginia minimum wage.
Claim for Unpaid Wages Form – Spanish
Complete este formulario si no ha pagado correctamente por su empleador o no se le pagaron el salario mínimo de Virginia.
On July 1, 2020, VA Code § 40.1-33.1 and VA Code § 40.1-33.2 went into effect.
PAYMENT OF WAGE ANTI-RETALIATION CLAIM FORM
VA Code § 40.1-33.2 prohibits an employer from retaliating against an employee for filing a Claim for Unpaid Wages with the Department and/or initiating a civil proceeding for unpaid wages.
If you believe you have been affected by an act of retaliation specifically related to filing a Claim for Unpaid Wages with the Department or filing a civil proceeding for unpaid wages, please complete this claim form.
MISCLASSIFICATION ANTI-RETALIATION CLAIM FORM
VA Code § 40.1-33.1 prohibits an employer from retaliating against an employee for reporting or planning to report to an appropriate authority that they have been misclassified by their employer.
If you believe you have been affected by an act of retaliation specifically for reporting or planning to report suspected misclassification, please complete this claim form.
WAGE SHARING ANTI-RETALIATION CLAIM FORM
VA Code § 40.1-28.7:9 prohibits an employer from retaliating against an employee for inquiring into or sharing information about the employee’s own wages or other compensation or about any other employee’s wages or other compensation.
If you believe you have been affected by an act of retaliation specifically related to wage sharing, please complete this claim form.