NEW YORK STATE OF OPPORTUNITY.

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.