Late or bounced paycheck checklist
A printable from Late or bounced paycheck. Fill it in by hand. Nothing you write is collected by this website.
Printable checklist
Is there a letter I can use?
Request for pay and payroll records
Date: ____________
To: ____________ (employer name and address)
I worked for you as a ____________ from ____________ to ____________.
[ ] My pay for the period ____________ was due on ____________ and has not been paid.
[ ] My paycheck no. ______ dated ______ for $______ was returned unpaid by the bank on ______.
Please pay me $______ by cash, cashier's check or direct deposit by ____________.
Under California Labor Code 226, I also ask to inspect or receive a copy of my payroll records and wage statements for ____________ to ____________.
Name: ____________ Phone or email: ____________
Signature: ____________
Keep a copy. Write down how and when you delivered it.
From Late or bounced paycheck. Facts checked October 21, 2026. Free information, not legal or medical advice.