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Get NY LS 54 2015

Print Employee Name Employee Signature Date Preparer s Name and Title 2. Notice given At hiring Before a change in pay rate s allowances claimed or payday LS 54 02/15 The employee must receive a signed copy of this form. The employer must keep the original for 6 years. 8. Employee Acknowledgement On this day I have been notified of my pay rate overtime rate if eligible allowances and designated pay day on the date given below. I told my employer what my primary language is. Check one I have been given this pay notice in English because it is my primary language. My primary language is. I because the Department of Labor does not yet offer a pay notice form in my primary language. 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. Employer Information Name Doing Business As DBA Name s FEIN optional 3. Employee s rate of pay per hour 4. Allowances taken None Tips Meals Lodging Other per meal 5. Regular payday Physical Address Mailing Address 6. Pay is Weekly Bi-weekly Phone 7. Overtime Pay Rate per hour This must be at least 1 times the worker s regular rate with few exceptions. 8. Employee Acknowledgement On this day I have been notified of my pay rate overtime rate if eligible allowances and designated pay day on the date given below. I told my employer what my primary language is. Check one I have been given this pay notice in English because it is my primary language. My primary language is. I because the Department of Labor does not yet offer a pay notice form in my primary language. 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. Employer Information Name Doing Business As DBA Name s FEIN optional 3. Employee s rate of pay per hour 4. Employer Information Name Doing Business As DBA Name s FEIN optional 3. Employee s rate of pay per hour 4. Allowances taken None Tips Meals Lodging Other per meal 5. Regular payday Physical Address Mailing Address 6. Allowances taken None Tips Meals Lodging Other per meal 5. Regular payday Physical Address Mailing Address 6. Pay is Weekly Bi-weekly Phone 7. Overtime Pay Rate per hour This must be at least 1 times the worker s regular rate with few exceptions. Pay is Weekly Bi-weekly Phone 7. Overtime Pay Rate per hour This must be at least 1 times the worker s regular rate with few exceptions. 8. Employee Acknowledgement On this day I have been notified of my pay rate overtime rate if eligible allowances and designated pay day on the date given below. 8. Employee Acknowledgement On this day I have been notified of my pay rate overtime rate if eligible allowances and designated pay day on the date given below. I told my employer what my primary language is. Check one I have been given this pay notice in English because it is my primary language. I told my employer what my primary language is. Check one I have been given this pay notice in English because it is my primary language. My primary language is. I because the Department of Labor does not yet offer a pay notice form in my primary language. .

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