Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 ...
Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law
Notice for Hourly Rate Employees
Empl ID#:___________________________
1. Employer Information Name:
CUNY Graduate School and University Center
Doing Business As (DBA)
CUNY - The Graduate Center CUNY - The Craig Newmark Graduate School of Journalism
Name(s): FEIN (optional):
Physical Address:
365 Fifth Avenue, Suite # 7201 New York, NY 10016-4309
Mailing Address:
3. Employee's rate of pay:
$
per hour
4. Allowances taken: X None Tips SKIP per hour Meals SKIP per meal Lodging SKIP
Other N/A
5. Regular payday: FWS Payroll Calendar (attached)
6. Pay is: Weekly
X Bi-weekly Other
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
have been given this pay notice in English
only, because the Department of Labor
does not yet offer a pay notice form in my
primary language.
Print Employee Name
Phone: (212) 817 - 7460
7. Overtime Pay Rate: $ N/A per hour (This must be at least 1? times the worker's regular rate with few exceptions.)
Employee Signature
______________________________ Date
2. Notice given: At hiring Before a change in pay rate(s), allowances claimed or payday
LS 54 (09/22)
Preparer's Name and Title
Anne V Johnson, Financial Aid Counselor, FWS/SEP Pgms.
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.
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