ࡱ> ceb bjbjOO l-c-c '''''$KKKK<K0$~!='r"=''{R''q h0T"T"T"'T0"==T" : Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law Notice for Hourly Rate Employees 1. Employer Information Name: Doing Business As (DBA) Name(s): FEIN (optional): Physical Address: MailingAddress: Phone:  2. Notice given:  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  At hiring  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Before a change in pay rate(s), allowances claimed or payday LS 54 (01/17) 3. Employees rate of pay: $ per hour 4. Allowances taken:  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  None  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Tips per hour  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Meals per meal  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Lodging  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Other 5. Regular payday: 6. Pay is:  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Weekly  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Bi-weekly  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  Other 7. Overtime Pay Rate: $ per hour (This must be at least 1 times the workers regular rate, with few exceptions.) 8. Employee Acknowledgement: On this day I have been notified of my pay rate, overtime rate (if eligible), allowances, and designated payday on the date given below. I told my employer what my primary language is. Check one:  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  I have been given this pay notice in English because it is my primary language.  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