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. Employee Information

2. Notice given:

3. Employee's rate of pay:
$ per hour

4. Allowances taken:

5. Regular payday:

6. Pay Is:

7. Overtime Pay Rate:
Most workers in NYS must receive at least 1½ 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 1½ 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 told my (If eligible), allowances, and designated pay day on the date given below. I told my employer what my primary language is.
Check one:

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. Employers also may not prohibit employees from discussing wages with their co-workers.