Montana Electronic Wage Claim Preparation Worksheet

MONTANA ELECTRONIC WAGE CLAIM PREPARATION WORKSHEET

Before you use this: The Montana Department of Labor and Industry directs wage claimants to its Electronic Wage Claim after trying to resolve the concern with the employer. The Department also identifies a district court complaint as a separate possible route. Choose the route for your actual facts before filing. For a claim under Mont. Code Ann. § 39-3-207(1), the complaint must be filed within 180 days of the default or delay in payment. Other wage laws and claim routes may have different periods. Preparing this worksheet does not file a claim.

1. People and work

Your full name: [________________________________]

Mailing address: [________________________________]

Email and phone: [________________________________]

Employer's business name: [________________________________]

Employer's contact person: [________________________________]

Employer's mailing address, email, and phone: [________________________________]

Work location and dates worked: [________________________________]

Job duties and pay agreement: [________________________________]

Status: ☐ Still employed ☐ Employment ended on [__/__/____]

2. Wage items

Select the category or categories that match your actual claim. The Department's electronic process asks for each category's time period and estimated amount.

☐ Unpaid regular wages ☐ Minimum wage ☐ Overtime ☐ Commissions ☐ Production-based bonus ☐ Tips ☐ Earned vacation or paid time off under the applicable policy ☐ Improper wage withholding ☐ Prevailing wage or fringe benefit ☐ Other [________________________________]

Explain each calculation, including hours, rates, commission terms, deductions, or payments already received: [________________________________]

When you first learned payment was delayed or withheld: [__/__/____]

For each Montana Wage Payment Act item, your calculated 180-day filing date from default or delay: [________________________________]

3. Supporting facts and records

What you told the employer about the unpaid wages, with date and response: [________________________________]

Documents to attach as appropriate: ☐ pay stubs ☐ time cards or time sheets ☐ wage agreement ☐ commission or bonus policy ☐ vacation or paid-time-off policy ☐ messages ☐ bank records ☐ other [________________________________]

Brief factual explanation of the claim and how the documents support it: [________________________________]

Any lawsuit already filed for the same wages, union agreement requiring interpretation, independent-contractor issue, or work outside Montana to disclose and discuss with the Department: [________________________________]

4. Submit through the Department's route

☐ Review the Department's current wage claim instructions, including what falls within its authority and how it handles submitted information.

☐ Open the Electronic Wage Claim linked from that page and transfer your answers and supporting copies. The agency also says paper forms can be requested from Job Service offices or by contacting its wage program.

☐ Provide your Social Security number only in the Department's official claim process if requested; do not record it on this worksheet.

☐ Save the submission confirmation and a copy of what you provided. Record the filing date and confirmation number: [________________________________]

The Department's instructions say information and documents you submit as part of the wage claim are not confidential. Check the attachments before submitting them.

Official sources

• Mont. Code Ann. § 39-3-207
• Montana Department of Labor and Industry wage claim instructions