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Get NY Notice of Hourly Rate Employees

Please fill in Sections 2 3 and 8. Sign and Date. 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 Barnard College Physical Address 117th Street and Broadway New York New York 10027 Mailing Address 3009 Broadway Phone 212-854-2033 2. 1 of the New York State Labor Law Notice for Hourly Rate Employees 1. Employer Information Name Barnard College Physical Address 117th Street and Broadway New York New York 10027 Mailing Address 3009 Broadway Phone 212-854-2033 2. Notice Given At hiring On or before February 1 Before a change in pay rate s allowances claimed or payday 3. Notice Given At hiring On or before February 1 Before a change in pay rate s allowances claimed or payday 3. Employee s rate s of pay for each type of work or shift for Hourly Rate Job Title 4. Allowances taken None Tips per hour Meals per meal Lodging Other 5. Regular payday Friday 8. Employee Acknowledgement On this day I have been notified of my pay rate overtime rate if eligible allowances and designated payday 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. only because the Department of Labor does not yet offer a pay notice form in my primary language. Print Employee Name Employee Signature 6. Pay is Bi-weekly Date 7. Overtime Pay Rate s for each type of This must be at least 1 times the worker s weighted average of the multiple rates of pay for the week with few exceptions. Employee s rate s of pay for each type of work or shift for Hourly Rate Job Title 4. Allowances taken None Tips per hour Meals per meal Lodging Other 5. Regular payday Friday 8. Employee Acknowledgement On this day I have been notified of my pay rate overtime rate if eligible allowances and designated payday 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. only because the Department of Labor does not yet offer a pay notice form in my primary language. Print Employee Name Employee Signature 6. Pay is Bi-weekly Date 7. Overtime Pay Rate s for each type of This must be at least 1 times the worker s weighted average of the multiple rates of pay for the week with few exceptions. The weighted average is the total regular pay divided by the total hours worked in the week. The overtime rate may vary from week to week depending on how many hours you worked at each rate of pay. The overtime rate may vary from week to week. Won Kang Associate Director for Student Employment Preparer Name and Title The employee must receive a signed copy of this form* The employer must keep the original for 6 years. Please return the original to Career Development 2nd Floor of Elliott Hall immediately. Copies can be made for you at the office. Employee s rate s of pay for each type of work or shift for Hourly Rate Job Title 4. Allowances taken None Tips per hour Meals per meal Lodging Other 5. Regular payday Friday 8. Employee Acknowledgement On this day I have been notified of my pay rate overtime rate if eligible allowances and designated payday on the date given below. .

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