Form Mw-31a - Wage Claim
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1
2OFFICIAL USE ONLY:
NJ Dept. of Labor & Workforce Development
Tel. (609) 292-2305
Claim#
Empl#
Division of Wage and Hour Compliance
Fax (609) 695-1174
Field___
IBM___
WC___
No Jurisdiction___
PO Box 389
wage.hour@dol.state.nj.us
Field Rpt#
Trenton, NJ 08625-0389
Case#
WAGE CLAIM
All workers, including undocumented workers, have a right to be paid for their work. The Division of Wage and Hour Compliance
does not investigate the legal status of any worker. We apply New Jersey’s labor laws equally to all workers, regardless of legal
status. We do not share information with “Immigration.”
Instructions: Complete both sides of this form and answer all questions. Type or print legibly. Attach a copy of your last paycheck
and W-2 form if you have them. Attach any other documents that support your claim. Mail or fax all documents to the address at
the top of this page.
For more information about filing a wage claim, visit
. Click on Wage & Hour and go to the section on “File a Wage
Claim.”
Filing by e-mail: You may file your claim electronically by sending an e-mail to Wage & Hour and attaching this completed
document in Adobe Portable Document Format (PDF) format. If you file by e-mail, scan all your supporting documents (last paycheck
or W-2 form) into PDF format, and attach the PDF(s) to your e-mail.
Filing Anonymously: Your employer has the right, under the Open Public Records Act (OPRA), to see all information on this claim.
If you want to file an anonymous claim, write “ANONYMOUS” in the name section and leave the address blank. Provide as much
information as you can without revealing personal details. Mail or fax your claim. If you want to remain anonymous, do NOT send
your claim by e-mail.
Employee Information
1.
First Name
Last Name
M.I.
3.
Daytime Telephone No.
(
)
2.
Mailing Address
Floor / Apt. No.
4.
Cell / Alternate Telephone No.
(
)
(if you prefer, leave blank)
City
State
ZIP Code
5.
Social Security No.
(such as an attorney, agency, or legal service)
6.
Is a third party
submitting this claim as your representative or agent?
Yes
If yes, answer items #7 - 11.
No
f no, go to item #12.
7.
Name of Person, Agency or Service
9.
Third Party Telephone No.
(
)
8.
Mailing Address
10. Fax No.
(
)
City
State
ZIP Code
11. e-mail
Employment Information
12. Business Name
15. Business Telephone No.
(
)
(not a P.O. Box)
13. Business Street Address
16. Fax No.
(
)
Cit
ZIP Code
County
17. e-mail
(if different from street address)
14. Business Mailing Address
18. Name & Title of Contact Person
City
State
ZIP Code
19. Contact Telephone No.
MW-31A (R-1-1 -16)
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Parent category: Legal