Labor and Employment Law 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.
Anti-Retaliation Claim Form – On July 1, 2020, VA Code § 40.1-33.1 and VA Code § 40.1-33.2 went into effect. Statute VA Code § 40.1-33.1 grants employees new rights in disputes with their employers pertaining to their classification as an employee or independent contractor. Statute VA Code § 40.1-33.2 grants employees new rights in disputes with their employers over payment of wage issues. Download the Instructions and Form.