Alaska Wage Claim Application Preparation Worksheet
ALASKA WAGE CLAIM APPLICATION PREPARATION WORKSHEET
Before you use this: Alaska Labor Standards and Safety publishes a Wage Claim packet, revised December 4, 2025, with instructions, a wage claim form, calculation sheet, claimant statement, assignment, and hours worksheets. Complete and submit the official packet, not this worksheet. Read the packet's eligibility checklist and every signature page. Its assignment gives the Department authority to pursue and settle the claim, including for less than the full amount, without further approval. Decide whether to sign it only after understanding those terms.
1. Claimant and employer facts
Your name and mailing address: [________________________________]
Current phone and email: [________________________________]
Employer's legal or business name: [________________________________]
Workplace and company mailing addresses: [________________________________]
Business owner, hiring person, and supervisor, if known: [________________________________]
Date hired and date employment ended, if applicable: [________________________________]
Occupation and work location: [________________________________]
Why employment ended, if applicable: [________________________________]
Did you ask the employer for wages? ☐ Yes ☐ No; date, amount, and reply: [________________________________]
2. Pay agreement and calculation
Promised pay rate and unit: [________________________________]
Pay rate at separation, if different: [________________________________]
Regular payday and pay frequency: [________________________________]
Usual daily and weekly hours, excluding meal breaks: [________________________________]
Written agreement or union contract, if any: [________________________________]
Room and board arrangement or charges, if any: [________________________________]
| Work period | Straight-time hours and rate | Overtime hours and rate | Other claimed wages | Payments or advances | Amount claimed |
|---|---|---|---|---|---|
| [DATES] | [HOURS/RATE] | [HOURS/RATE] | $[____] | $[____] | $[____] |
| [DATES] | [HOURS/RATE] | [HOURS/RATE] | $[____] | $[____] | $[____] |
| Total | $[____] | $[____] | $[____] |
Explain any vacation, return transportation, bonus, commission, or other amount claimed and its basis: [________________________________]
Explain the payments, advances, or other offsets in the calculation: [________________________________]
3. Claimant statement and records
Describe, in your own words, why you believe the wages are owed, who you asked to pay them, and what the employer said: [________________________________]
Records to copy for the official packet: ☐ personal time records ☐ hiring agreement ☐ employer policy ☐ pay statements ☐ messages ☐ bonus or commission terms ☐ other [________________________________]
If a payroll check was returned unpaid, identify who holds the original and gather the information the packet requests: [________________________________]
4. Complete the official packet
☐ Review the packet's checklist for claim amount, employer type, and other screening questions. Ask the nearest regional Wage and Hour office about any uncertainty.
☐ Transfer accurate facts and calculations to the official claim form, calculation sheet, statement, and hours worksheets. The official packet asks for identity information; enter it there rather than on this worksheet.
☐ Read the statement verification and the assignment of wage claim on page 5. The assignment permits Department action and settlement and affects your ability to pursue the same claim on your own while assigned. Do not sign based solely on this worksheet.
☐ Complete every signature the packet requires and send the official packet and copies of supporting records to the regional office indicated in its current instructions.
Date and method of submission: [________________________________]
Office and delivery confirmation: [________________________________]
Keep a copy of the official application and its attachments.
Official source
About this template
- Last updated
- October 27, 2026
- Last reviewed
- October 27, 2026
- Jurisdiction
- Alaska
- Category
- Employment & HR
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 27, 2026.
Alaska Labor Standards and Safety Wage Claim, rev. 12/4/25 (checked October 27, 2026): "The Wage Claim Form gives the Department information, details, and history about your case. The form must be complete and exact."
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