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Wage Claim Form - Industrial Commission of Arizona 2026

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The document is a wage claim form from the Industrial Commission of Arizona, designed for individuals to report unpaid wages. It collects personal information, employment details, and specifics about the wage dispute, including payment agreements and reasons for non-payment. The form emphasizes the importance of completeness to avoid delays in processing the claim.

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Click ‘Get Form’ to open it in the editor.
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.
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.
Indicate your rate of pay and how often you were paid. Select the appropriate options regarding wage agreements and payment methods.
Complete the sections regarding unpaid wages, including any deductions or additional claims. Be thorough to avoid delays in processing.
Review all entered information for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (29 Votes)
2011	4.7 Satisfied (60 Votes)

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How to file a wage claim in Arizona?

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.

How long can an employer not pay you in Arizona?

After 10 days, the employer will be required to pay three times the amount of unpaid wages.

How do I file a complaint against my employer in Arizona?

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.

Who do I contact if I dont get paid?

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.

What is the statute of limitations on wage claims in Arizona?

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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Can you sue a job for not paying you for working in Arizona?

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.