[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-348545-105":53,"doc-detail-348545-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","wage-statement","Wage Statement","","Wage Statement form for documenting an employee’s wages based on examined payroll records. It records claim details and identifies the employee and employer, including the relevant date of alleged injury. The form explains that if the employee worked an insufficient period to compute a proper average weekly wage, wages are instead estimated using a similarly engaged fellow employee who worked a substantial part of the prior year. A structured table captures weeks ending, days worked, and amounts paid, with totals.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/wage-statement/348545/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/wage-statement/348545.png","ImageObject",442,249,{"name":88,"@type":89},"Jacob","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information does this Wage Statement capture?","Question",{"text":109,"@type":110},"It captures claim number, employee and employer information, the date of alleged injury, and a wage table showing weeks ending, days worked, and amount paid.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How is the average weekly wage determined on this form?",{"text":114,"@type":110},"If the employee did not work long enough to determine a proper average weekly wage, the form uses a similarly engaged fellow employee’s weeks and wages from the prior year.",{"name":116,"@type":107,"acceptedAnswer":117},"What do the table totals represent?",{"text":118,"@type":110},"The table includes line items for weeks and a summary section that shows total amounts paid for the listed periods.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},348545,1791206556,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},962084931830,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","WAGE STATEMENT  \nDATE   CLAIM NUMBER   EMPLOYEE   EMPLOYER    \nI have examined our payroll records and the following table shows the weeks worked and the wages earned by the above-named employee during the period stated therein (including bonus and overtime pay) .  \nI have examined our payroll records and find that the above-named employee did not work for said employer for a sufficient period to determine a proper average weekly wage. Therefore, the following table shows the weeks worked and wages earned by   a fellow employee of the same class who was similarly engaged by the same employer and who did work a substantial part of the year prior to   .  \n(Date of alleged injury)  \nPosition:   Signed By:    \n\n|  | Week Ending |  |  | Days\u003Cbr>Worked | Amount Paid |  | Week Ending |  |  | Days\u003Cbr>Worked | Amount Paid |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  | Month | Day | Year |  |  |  | Month | Day | Year |  |  |\n| 1 |  |  |  |  |  | 27 |  |  |  |  |  |\n| 2 |  |  |  |  |  | 28 |  |  |  |  |  |\n| 3 |  |  |  |  |  | 29 |  |  |  |  |  |\n| 4 |  |  |  |  |  | 30 |  |  |  |  |  |\n| 5 |  |  |  |  |  | 31 |  |  |  |  |  |\n| 6 |  |  |  |  |  | 32 |  |  |  |  |  |\n| 7 |  |  |  |  |  | 33 |  |  |  |  |  |\n| 8 |  |  |  |  |  | 34 |  |  |  |  |  |\n| 9 |  |  |  |  |  | 35 |  |  |  |  |  |\n| 10 |  |  |  |  |  | 36 |  |  |  |  |  |\n| 11 |  |  |  |  |  | 37 |  |  |  |  |  |\n| 12 |  |  |  |  |  | 38 |  |  |  |  |  |\n| 13 |  |  |  |  |  | 39 |  |  |  |  |  |\n| 14 |  |  |  |  |  | 40 |  |  |  |  |  |\n| 15 |  |  |  |  |  | 41 |  |  |  |  |  |\n| 16 |  |  |  |  |  | 42 |  |  |  |  |  |\n| 17 |  |  |  |  |  | 43 |  |  |  |  |  |\n| 18 |  |  |  |  |  | 44 |  |  |  |  |  |\n| 19 |  |  |  |  |  | 45 |  |  |  |  |  |\n| 20 |  |  |  |  |  | 46 |  |  |  |  |  |\n| 21 |  |  |  |  |  | 47 |  |  |  |  |  |\n| 22 |  |  |  |  |  | 48 |  |  |  |  |  |\n| 23 |  |  |  |  |  | 49 |  |  |  |  |  |\n| 24 |  |  |  |  |  | 50 |  |  |  |  |  |\n| 25 |  |  |  |  |  | 51 |  |  |  |  |  |\n| 26 |  |  |  |  |  | 52 |  |  |  |  |  |\n|  |  |  |  | Total $ | 0.00 |  |  |  |  | Total $ | 0.00 |\n|  |  |  |  |  | Entire Total $ | 0.00 |  |  |  |  |  |","cbCaiv7tfCDI0Jnv","https://ap.wps.com/l/cbCaiv7tfCDI0Jnv","pdf",156582,"English","# Wage Statement Details\n## Payroll Record Examination and Average Wage Basis\n## Weekly Wages Table and Totals","[{\"question\":\"What information does this Wage Statement capture?\",\"answer\":\"It captures claim number, employee and employer information, the date of alleged injury, and a wage table showing weeks ending, days worked, and amount paid.\"},{\"question\":\"How is the average weekly wage determined on this form?\",\"answer\":\"If the employee did not work long enough to determine a proper average weekly wage, the form uses a similarly engaged fellow employee’s weeks and wages from the prior year.\"},{\"question\":\"What do the table totals represent?\",\"answer\":\"The table includes line items for weeks and a summary section that shows total amounts paid for the listed periods.\"}]","Wage Statement | PDF",1790074873]