North Dakota Claim for Wages - Preparation Worksheet
NORTH DAKOTA CLAIM FOR WAGES — PREPARATION WORKSHEET
Before you use this: Complete the Department of Labor and Human Rights' official Claim for Wages, using its wage claim process page for current filing instructions. This worksheet helps gather facts for that form; submitting this worksheet alone does not file a claim.
1. Filing route check
Under N.D.C.C. § 34-14-09(1), an employee's department claim must concern wages due within two years and claim at least $125 but no more than $15,000. The statute directs the Department to identify a small claims court opportunity if the claim is below $125 and a district court opportunity if it exceeds $15,000. The Department's process page also explains that it reviews jurisdiction after receiving a claim.
Date each disputed payment became due: [________________________________]
Amount claimed: $[________________________________]
☐ I was an employee for this work. ☐ My classification is disputed: [________________________________]
☐ I have not already filed a civil action or obtained a judgment for these same wages.
☐ Employer bankruptcy may affect the filing route: [________________________________]
2. Worker and employer
Worker name: [________________________________]
Mailing address: [________________________________]
Phone: [________________________________] Email: [________________________________]
Employer's legal and business names: [________________________________]
Worksite: [________________________________]
Payroll or supervisor contact: [________________________________]
3. Work and pay
Job or duties: [________________________________]
First work date: [__/__/____] Last work date, if ended: [__/__/____]
Agreed rate: $[________] per ☐ hour ☐ day ☐ week ☐ other [________]
Regular payday and pay period: [________________________________]
| Pay period | Hours or other basis | Rate | Wages claimed | Amount paid | Balance |
|---|---|---|---|---|---|
| [__/__/____] to [__/__/____] | [____] | $[____] | $[____] | $[____] | $[____] |
| [__/__/____] to [__/__/____] | [____] | $[____] | $[____] | $[____] | $[____] |
| [__/__/____] to [__/__/____] | [____] | $[____] | $[____] | $[____] | $[____] |
| Total | $[____] | $[____] | $[____] |
Explain rates, deductions, partial payments, and estimates: [________________________________]
4. Evidence and account
☐ Pay statements and payment records
☐ Time records and schedules
☐ Contract, offer letter, or rate messages
☐ Messages requesting payment or explaining a deduction
☐ Other: [________________________________]
Describe the work performed, pay promised, amounts paid, and unpaid balance. Identify estimates and missing records.
[____________________________________________________________]
[____________________________________________________________]
5. Transfer to official claim
Date official form submitted: [__/__/____]
Submission method: ☐ Online ☐ Mail ☐ Email ☐ In person
Confirmation or reference, if provided: [________________________________]
Copies retained at: [________________________________]
The Department says it reviews a received claim for jurisdiction and may reject one without required information. Preserve the submitted form, supporting records, and any Department response.
Sources
About this template
- Last updated
- November 2, 2026
- Citations checked
- November 2, 2026
- Jurisdiction
- North Dakota
- Category
- Employment & HR
Legal authority
- N.D.C.C. § 34-14-09(1) (department wage-claim filing range and timing)
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 November 2, 2026.
N.D.C.C. § 34-14-09(1) (checked November 2, 2026): "An employee may file with the department a claim for wages due under this chapter or under chapter 34-06 if the filing is made within two years from the date the wages are due"
North Dakota Department of Labor and Human Rights, Wage Claim Process (checked November 2, 2026): "The wage claim may be submitted online, or in paper copy via mail, e-mail, or in-person."
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