Wage statement template 2025

1. Click ‘Get Form’ to open the wage statement template in the editor.
2. Begin by filling in your personal information. Enter your name in the 'Employee' field and your employer's name in the 'Employer' section.
3. Next, input the 'Date of injury' and 'Claim #' if applicable. This information is crucial for processing any claims related to your wages.
4. Fill out the 'Date employed' and 'Social Security #' fields to provide necessary employment details.
5. In the 'Job title' and 'Class code' sections, specify your position and classification for accurate record-keeping.
6. Indicate your hourly rate and normal schedule work hours to clarify your compensation structure.
7. For each week leading up to the date of injury, list gross wages paid. If no wages were earned during a week, write ‘none’ under Gross Wages Paid.
8. Finally, calculate and enter the total gross wages paid and number of weeks used in calculation at the bottom of the form.
9. Complete the form by signing it in the 'Completed by' section along with today's date.

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