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Wage Claim Form - Industrial Commission of Arizona 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, address, and contact details. Ensure accuracy as this information is crucial for processing your claim.
  3. Fill out the employment details section. Include your job title, type of work performed, and the names and titles of those who hired and supervised you.
  4. Indicate your rate of pay and how often you were paid. Select the appropriate options regarding wage agreements and payment methods.
  5. Complete the sections regarding unpaid wages, including any deductions or additional claims. Be thorough to avoid delays in processing.
  6. Review all entered information for accuracy before signing and dating the form at the bottom.

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The completed Unpaid Wage Claim Form may be submitted (1) Electronically by completing the Sign and Submit Form below; (2) by e-mail to Laborinv@azica.gov; (3) by Fax to (602)-542-8097; or (4) by U.S. Mail to Labor Department, P.O. Box 19070, Phoenix, AZ 85005-9070.
After 10 days, the employer will be required to pay three times the amount of unpaid wages.
To file a complaint, you may complete one of the following two options: File a complaint online. or. Fill out the Complaint/Apparent Violation Form . Once the form is completed, you may submit it by any way below: Email it to DERSazcomplaints@azdes.gov.
Help checking your pay talk to your employer, payroll team or manager. talk to your trade union representative, if youre a member. contact the Acas helpline for more advice.
Under the Fair Labor Standards Act (FLSA), which governs wage and hour claims, employees have two years from the date of the violation to file a lawsuit. However, if the violation is deemed willful, the statute of limitations extends to three years.

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If an employer fails to pay an employee, the employee may recover the full amount of money they are owed in a claim or lawsuit, as explained above. They may file a claim with the federal Department of Labor, a lawsuit in an Arizona civil court, or a union grievance procedure.

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