Online Wage Claim Form

Note: You cannot file a claim for wages more than two years after the date they are due.

If you need assistance completing this form, please contact the Wage and Hour Unit at the information below.

Wage and Hour Unit
Vermont Department of Labor
63 Pearl Street
Burlington, VT 05401-4331
Telephone: 802-951-4083 FAX: 802-863-7655

Your Information
Business Information
Section 1- Complaint Basis
If this is NOT a Claim for Wages you may STOP here! Please Sign and Date and click the "Submit" Button at the end of the form.
Section 2 Wage Claim Information
Week 1
Week 2
Week 3
Week 4
Reimbursement Claim Information
Reimbursement Week 2
Reimbursement Week 3
Reimbursement Week 4
Improper Deductions Information
Deductions Week 1
Deductions Week 2
Deductions Week 3
Deductions Week 4
Unpaid Leave Claim Information
Leave Week 1
Leave Week 2
Leave Week 3
Leave Week 4
Section 3- Employment Agreement Information
By checking this box, I hereby certify that, to the best of my knowledge, this statement is true. I understand that a copy of this claim, and any materials that I submit to the Wage and Hour Program relative to this claim, will be forwarded to my employer and/or employer's representative.

Printable Wage Claim Complaint Form

Contact Information

COVID-19 Update: Department of Labor regional offices are currently operating with limited times for in-person services due to COVID-19 and staffing limitations. To see when your local office is open for in-person services click here.

Vermont Department of Labor
5 Green Mountain Drive
P.O. Box 488
Montpelier, 05601-0488
(802) 828-4000

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