How to Fill Out the Minnesota Employee Wage Notice Form

Every Minnesota employer must give each new hire a completed Minnesota employee wage notice form on or before the first day of work, and must reissue it in writing any time the information changes. The Minnesota Department of Labor and Industry (DLI) publishes a free fill-in template that covers every field the statute requires, and using it is the simplest way to stay compliant.

When You Have to Deliver It

Minnesota Statutes section 181.032 requires the notice at the start of employment, which means on or before day one, not after.¹ Every employer is covered, regardless of size or industry.

After the initial notice, you owe the employee an updated written version any time the information on the form changes, and the update has to reach them before the change takes effect.¹ A raise, a change in overtime status, a new payroll deduction, or a revised paid-time-off policy all trigger a fresh notice. If the first paycheck under the new terms arrives before the written update does, you are already late.

What Goes on the Form

The DLI template at dli.mn.gov walks through every required field in order.² You can build your own form, but matching the state template field for field is the easiest way to make sure nothing is missing. Here is what each section asks for:

Employee information: Full name, address, phone, email, and the date employment begins.³
Employer information: Legal business name, any operating name, physical address of your main office, mailing address if different, phone, and email.¹
Employment status: Mark whether the employee is exempt or non-exempt. If exempt, check the boxes showing whether the exemption covers minimum wage, overtime, or other provisions of Minnesota Statutes chapter 177, and write in the legal basis. If non-exempt, check the box confirming the employee is entitled to overtime and minimum wage.³
Rate of pay: Enter the dollar amount and check how pay is calculated: hourly, salary, piece rate, commission, shift, day, week, or other. If overtime applies, note the number of hours after which it kicks in.¹
Meal and lodging allowances: If you claim any allowances against pay for meals or lodging, list the dollar amounts. Meal allowances are capped at 60 percent of one hour of the adult minimum wage per meal; lodging allowances at 75 percent per day.³
Leave benefits: Check the types of paid leave the employee receives (sick leave, vacation, other paid time off), then fill in how time accrues (hours or days per year, month, pay period, or hours worked) and the terms of use.¹
Deductions: List every deduction that could be taken from pay, with amounts. This is one of the most frequently skipped fields. Leave it blank, add deductions later, and the employee disputes them, and you have no documented authorization.¹
Pay period and payday: Enter the number of days in the pay period, the regularly scheduled payday, and the date of the first paycheck. Minnesota wages must be paid at least once every 31 days.³⁴
Other information: An open text field for anything else relevant to the job that does not fit the categories above.

Getting Exempt or Non-Exempt Right

The exemption field is the costliest one to misfill, because a misclassified employee may be owed back overtime on top of any notice violation. The form must state whether the employee is exempt from overtime, non-exempt from overtime, or non-exempt from minimum wage and overtime under both the federal Fair Labor Standards Act and Minnesota Statutes chapter 177.¹

For the common federal white-collar exemptions (executive, administrative, and professional), the employee must be paid on a salary basis of at least $684 per week ($35,568 per year) and meet specific duties criteria. Job titles alone do not control. An “Office Manager” who does not actually supervise two or more employees and has no hiring or firing authority would not qualify for the executive exemption regardless of the title.⁵ When in doubt, classify the worker as non-exempt. The consequences of wrongly denying overtime are far worse than paying overtime you did not technically owe.

Language and Translation

Prepare the notice itself in English, but include a printed statement in multiple languages telling the employee they can request the notice in another language.¹ The DLI template already includes this multilingual statement at the bottom, so using the state’s form satisfies this requirement automatically.³

When an employee does ask for the notice in another language, you have to provide a translated version. The DLI offers pre-translated templates in 18 languages, including Spanish, Hmong, Vietnamese, Somali, Karen, Arabic, and Khmer.² For languages the DLI does not cover, the form lists translation providers approved by the Minnesota Department of Administration.³ Keep a record of every translation request and the date you delivered the translated form.

Delivery and Signature

You can deliver the notice on paper or electronically. If you deliver it electronically, give the employee a way to keep their own copy, whether that means printing it, downloading it to a personal device, or both. Electronic signatures count for the acknowledgment of receipt.⁶

Either way, the employee has to sign the notice confirming receipt, and you have to keep that signed copy.¹ The DLI template has signature and date lines for both the employer and the employee at the bottom.³ The signed notice is your primary evidence of the agreed terms if a wage dispute ever reaches a hearing.

Keeping the Signed Copy

The statute requires employers to keep the signed notice on file but does not set an exact retention period.¹ Federal law under the FLSA requires employers to preserve payroll records for at least three years.⁷ Holding the signed notice for at least three years after the employment relationship ends is the safer approach, since that window covers most wage-related claims. Many employers keep them longer.

Store the original notice and every updated version together so you can show a complete timeline of each pay rate, schedule, or deduction change for every worker. If an investigator or attorney asks for these records and you cannot produce them, the gap tends to work against you.

Penalties for Non-Compliance

Failing to provide the notice, or failing to keep the signed copy on file, exposes employers to civil penalties enforced by the DLI. Under Minnesota Statutes section 177.30, fines can reach $1,000 for each failure to maintain required records and up to $5,000 for each repeated failure. For willful or repeated violations of wage-related statutes more broadly, Minnesota Statutes section 177.27 allows additional penalties of up to $10,000 per violation per employee.⁸ Business size and severity factor into the amount assessed.

Separately, a missing or incomplete notice weakens your position in any wage dispute. If an employee claims they were promised a higher rate or different overtime terms, the signed notice is the document that resolves it. Without it, the employee’s account carries more weight.

1
Minnesota Office of the Revisor of Statutes. Minnesota Code 181.032 – Required Statement of Earnings by Employer; Notice to Employee
2
Minnesota Department of Labor and Industry. Employee Wage Notice
3
Minnesota Department of Labor and Industry. Minnesota Employee Notice Form
4
Minnesota Office of the Revisor of Statutes. Minnesota Code 181.101 – Payment of Wages
5
U.S. Department of Labor. Fact Sheet 17A: Exemption for Executive, Administrative, Professional, Computer and Outside Sales Employees Under the Fair Labor Standards Act
6
Minnesota Department of Labor and Industry. Wage Theft Q&A
7
U.S. Department of Labor. Fact Sheet 21: Recordkeeping Requirements Under the Fair Labor Standards Act
8
Minnesota Office of the Revisor of Statutes. Minnesota Code 177.27 – Department of Labor and Industry Powers