ࡱ> NPM k?bjbj 4Hkhh&&&8^|4&.*$$$$Y)[)[)[)[)[)[)$+.n)i")$$)^8$$Y)Y)$ F5Bu+HE))0.*,.Nv..D )).*.h : Notice and Acknowledgement of Pay Rate and Payday V3-R5411 Under Section 195.1 of New York Labor Law NY State requires that ALL employees be given notice of their rate of pay, wage status and payday at time of hire. For freelance employees this notice must be provided for each project for which they are hired. They must be paid the agreed rate for all work in the hired category for that project. If their job changes, the rate can change, but a new Notice must be issued. Employer/Production Co. Name/DBA_______________________________________________________ FEIN (Optional) ___________ Physical address _______________________________________ City __________________________State ______ Zip ___________ Mailing add.(If different)__________________________________ City __________________________State ______ Zip ___________ Phone (____) ____ - ________ Employer of Record: _______________________________________________________________________ Employee: Name __________________________________________Your Job/Occupation Category is: _____________________ Project Name/# ___________________________________________________ Work Start Date ___________ Non-Exempt Employees : Your rate of pay is: $______ per hour. Weekly Overtime : Your overtime rate of pay is: $_______ per hour. (Overtime rate must be at least 1 times the workers regular rate, to be paid after 40 regular hours in work week.) ------ OR ------ Daily Overtime: Daily after ____ hours $ ______ per hour, and after ____ hours $ ______ per hour and $ _____ per hour for all hours over 40 weekly. IF working under union contract: o Other terms and conditions per CBA _____________________________________Agmt/Local Exempt Employees: Employees pay rate(s): State if pay is based on salary for a period, day rate, or other basis. ______________________________________________________ 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(s) (optional): _________________________ o Other terms and conditions as per CBA ___________________________________________________________Agmt/Local Information on designation of Exempt categories is available at: http://www.dol.gov/whd/regs/compliance/fairpay/fs17a_overview.htm http://www.dol.gov/whd/regs/compliance/fairpay/fs17a_overview.pdf Allowances: There are no allowances taken by the Employer against the statutory minimum hourly rate of pay. If otherwise describe: __________________________________________________________________________________________________________ Regular pay day: ____________________o Weekly o Bi- Weekly o Other _______________If more frequent. Employee Acknowledgement: On this date, I received notice of my pay rate, overtime rate (if eligible), allowances, and designated payday. I told my employer what my primary language is. Check one: o I have been given this pay notice in English because it is my primary language. o My primary language is _________________ . I have been given this pay notice in English only, because the Department of Labor does not yet off!2UY[]^ ^ _ ` v w ʼʩ曊|n]K: h:UhCJOJQJ^JaJ#h:Uh5CJOJQJ^JaJ hPh~yCJOJQJ^JaJh4CJOJQJ^JaJh|%CJOJQJ^JaJ hzh~yCJOJQJ^JaJhQgh5OJQJ^J$hhhh5B*OJQJ^JphhCJOJQJ^JaJ h4h4CJOJQJ^JaJh45OJQJ^Jhh5OJQJ^Jh~yh5OJQJ^J^_ ` L H I p)d$d %d &d 'd N O P Q gd:U+dx$d %d &d 'd N O P Q gd:U&$d %d &d 'd N O P Q gd:Ugd$a$gd4gd4 w x | }       8 ͻͪ͜zi[[zMzMzh%VCJOJQJ^JaJh7CJOJQJ^JaJ hphCJOJQJ^JaJ h%VhZIzCJOJQJ^JaJ h7h7CJOJQJ^JaJhpCJOJQJ^JaJ h%VhCJOJQJ^JaJ#hNhN5CJOJQJ^JaJhNCJOJQJ^JaJ#h:Uh5CJOJQJ^JaJ#h:Uhp5CJOJQJ^JaJ8 < F G K L W f |  F ޿rdRdDhECJOJQJ^JaJ#hzhm5CJOJQJ^JaJh:UCJOJQJ^JaJ#h%Vh>*CJOJQJ^JaJh%VCJOJQJ^JaJ h%Vh7CJOJQJ^JaJhCJOJQJ^JaJh7CJOJQJ^JaJhCJOJQJ^JaJ h%Vhv$CJOJQJ^JaJ h%VhCJOJQJ^JaJ h%VhZIzCJOJQJ^JaJF G H I Q R S T q t |  оzlz^zM?M1h7CJOJQJ^JaJh7CJOJQJ^JaJ h%Vh7CJOJQJ^JaJhpCJOJQJ^JaJh%VCJOJQJ^JaJ h%VhCJOJQJ^JaJ#hh5CJOJQJ^JaJhp5CJOJQJ^JaJ#h:Uhp5CJOJQJ^JaJ#h:Uh5CJOJQJ^JaJhCJOJQJ^JaJ hzhCJOJQJ^JaJ hp{huCJOJQJ^JaJI  _ <]4(<$d %d &d 'd N O P Q gd1i(x$d %d &d 'd N O P Q gd1i(<$d %d &d 'd N O P Q gdDo(x$d %d &d 'd N O P Q gd:U&$d %d &d 'd N O P Q gd:U   0 2 3 6 I K L R S \ άzi[M[< h7h7CJOJQJ^JaJhOCJOJQJ^JaJhB[>CJOJQJ^JaJ h%VhB[>CJOJQJ^JaJhp5CJOJQJ^JaJ#hphp5CJOJQJ^JaJ hp5>*CJOJQJ^JaJ&hzhz85>*CJOJQJ^JaJhBCJOJQJ^JaJh7CJOJQJ^JaJ h%Vh7CJOJQJ^JaJ#hph75CJOJQJ^JaJ\ ^ _ f n o p q 6:<̽q`qRqDq6qh'CJOJQJ^JaJhBCJOJQJ^JaJh7`CJOJQJ^JaJ hOhB[>CJOJQJ^JaJ hOhOCJOJQJ^JaJhB[>CJOJQJ^JaJ h%VhB[>CJOJQJ^JaJhvmCJOJQJ^JaJhpCJOJQJ^JaJhO5CJOJQJ^JaJ#hOhO5CJOJQJ^JaJ&hphO5>*CJOJQJ^JaJhOCJOJQJ^JaJ<DHTXbfh*,2BTʸ|||n|`O|> h7`hOCJOJQJ^JaJ hOh1iCJOJQJ^JaJh1iCJOJQJ^JaJh/CJOJQJ^JaJ hOhOCJOJQJ^JaJh7`CJOJQJ^JaJhOCJOJQJ^JaJhvm5CJOJQJ^JaJ#hOhO5CJOJQJ^JaJ&hOhO56CJOJQJ^JaJ hP56CJOJQJ^JaJ hO56CJOJQJ^JaJ<hA\\\&$d %d &d 'd N O P Q gdDo)dh$d %d &d 'd N O P Q gd1i(x$d %d &d 'd N O P Q gd1i(P$d %d &d 'd N O P Q gd1i-26AQRUﴣvvhVE h#`-h#`-CJOJQJ^JaJ#h#`-h#`-5CJOJQJ^JaJhz8CJOJQJ^JaJh1iCJOJQJ^JaJ hphpCJOJQJ^JaJhpCJOJQJ^JaJ hp5>*CJOJQJ^JaJ&hzhz85>*CJOJQJ^JaJhPCJOJQJ^JaJh?hOOJQJhOCJOJQJ^JaJ hOhOCJOJQJ^JaJW0&$d %d &d 'd N O P Q gdDo(P$d %d &d 'd N O P Q gdDo(x$d %d &d 'd N O P Q gdDo)d$$d %d &d 'd N O P Q gdDo+dtx$d %d &d 'd N O P Q gdDo,.Jfp_`ȷ򦕄seT?)jhh/CJOJQJU^JaJ hu1hn=CJOJQJ^JaJh/CJOJQJ^JaJ h%Vh/CJOJQJ^JaJ h%Vh7CJOJQJ^JaJ hvmh;kCJOJQJ^JaJ hOhBCJOJQJ^JaJ h#`-hzCJOJQJ^JaJh?h#`-OJQJhPCJOJQJ^JaJ h#`-h#`-CJOJQJ^JaJhBCJOJQJ^JaJ`uwڹyhyZhZhI;h QCJOJQJ^JaJ hh3nCJOJQJ^JaJhCJOJQJ^JaJ hh QCJOJQJ^JaJ hhCJOJQJ^JaJh5CJOJQJ^JaJh Q5CJOJQJ^JaJ hDohDoCJ OJQJ^JaJ hCJOJQJ^JaJ$hh/0JCJOJQJ^JaJ)jhh/CJOJQJU^JaJ hh/CJOJQJ^JaJ.-<.<<<<=>>dgdw&gdmgd7gdvm&$d %d &d 'd N O P Q gdBgd Q)d$d %d &d 'd N O P Q gdDogdz8$&(.0>@BDnɸ}}}}o^O=#hvmhvm5CJOJQJ^JaJhB5CJOJQJ^JaJ hBhBCJOJQJ^JaJhBCJOJQJ^JaJh7CJOJQJ^JaJ h%Vh7CJOJQJ^JaJh%Vh7OJQJ hj1hj1CJOJQJ^JaJ h%Vhj1CJOJQJ^JaJ#hvmhj15CJOJQJ^JaJ#hvmh75CJOJQJ^JaJ#hDoh Q5CJ OJQJ^JaJ ,.022<,<-<.<A<f<g<ﶥzkYH9h#`-5CJOJQJ^JaJ hFh#`-CJOJQJ^JaJ#hFh#`-5CJOJQJ^JaJhvm5CJOJQJ^JaJ he*hPCJOJQJ^JaJU.jh1iCJOJQJU^JaJmHnHu hOhvmCJOJQJ^JaJh?hvmOJQJ#hvmhvm5CJOJQJ^JaJhvmCJOJQJ^JaJhBCJOJQJ^JaJ hvmhvmCJOJQJ^JaJer a pay notice form in my primary language. Employee Signature _____________________________________ Date: _________ _______________________________________________________________ Preparers Name and Title The abovenotice is solely for purposes of compliance with NY Labor Law Sec. 195.1 and does not alter the at will status of any at will employee recipient. This form is made available asa guide to assistAICP membersin NY Labor Law Sec. 195.1 compliance. It is not intended aslegal advice noras asubstitute for review by legal counsel. Duplicate signed copies to be provided to the employee and payroll service. Original to be retained by the Employer/Production Co.     The employee must receive a signed copy of this form. 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