ࡱ> `b_ bjbjOO h-c-c <<$+<00gCCCC$`!/"//CC{/CC/CUdE 00!O!!0"2NO0////!< I: Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law Notice for Exempt 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 59 (01/17) 3. Employee's pay rate(s): State if pay is based on an hourly, salary, day rate, piece rate or other basis. Employers may not pay a non-hourly rate to a non-exempt employee in the Hospitality Industry, except for commissioned salespeople. 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: Most workers in NYS must receive at least 1 times their regular rate of pay for all hours worked over 40 in a workweek, with few exceptions. A limited number of employees must only be paid overtime at 1 times the minimum wage rate, or not at all. This employee is exempt from overtime under the following exemption (optional): 8. Employee Acknowledgement: On this day I have been notified of my pay rate, overtime rate (if eligible), allowances, and designated payday. 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.  INCLUDEPICTURE "http://cdn01.icims.com/20050907141207/images.icims.com/images/customers/check_off.gif" \* MERGEFORMATINET  My primary language is . I have been given this pay notice in English only, because the Department of Labor does not yet offer a pay notice form in my primary language. Employee Signature Date Preparer's Name and Title The employee must receive a signed copy of this form. The employer must keep the original for 6 years. Please note: It is unlawful for an employee to be paid less than an employee of the opposite sex for equal work. 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