Notice of Pay Rates and Pay Day
Company name and address ________________________________________________________
Preparer's name and title ________________________________________________________
Employee's name and address ________________________________________________________
Your regular rate of pay will be $____ per hour for the first 40 hours in a week.
Your overtime rate of pay will be $____ per hour for hours over 40.
Your designated pay day will be: ________________________________________________________
FOR TIPPED EMPLOYEES ONLY:
The tip credit taken will be $_____ per hour.
If you do not receive enough tips over the course of a week to bring you up to the minimum hourly rates of $____ per hour for the first 40 hours and $____ per hour for hours over 40, you will be paid additional wages that week to make up the difference.
FOR SERVICE EMPLOYEES IN RESORT HOTELS ONLY (if different from rates given above): If your weekly average of tips received is at least $____ per hour, your regular rate of pay will be $____ per hour and your overtime rate of pay will be $____ per hour. The tip credit taken will be $____ per hour.
Preparer's signature and date ________________________________________________________
I have been notified of my pay rate, overtime rate, tip credit if applicable, and designated pay day on the date given below.
Employee's signature and date ________________________________________________________
N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 146-2.2