Form LS-59 PDF Details

In the landscape of employment paperwork, the LS 59 form plays a vital role for both employers and employees in New York State, by ensuring clear communication regarding the specifics of an individual's employment terms. This form functions under Section 195.1 of the New York State Labor Law, mandating employers to furnish employees with a written notice concerning their pay rate, payday, and any allowances claimed like tips, meals, and lodging. It is particularly distinctive for its comprehensive nature, covering a variety of payment structures including hourly, salary, day rate, piece rate, and others, while specifically noting that non-hourly rates for non-exempt employees in the Hospitality Industry are bound by additional rules. Furthermore, it sheds light on the regularity of paydays, whether weekly, bi-weekly, or otherwise, and clarifies to employees their eligibility for overtime pay—at least 1½ times their regular rate of pay for hours worked beyond 40 in a workweek, with certain exceptions. The form also includes a segment for employee acknowledgment, ensuring they have received and understood the terms of their employment, with a declaration of their primary language for accurate communication. This provision highlights the state's attempt to cater to diverse linguistic needs, although it currently provides notices primarily in English. Both employees and employers are required to keep signed copies, with employers maintaining the original for six years—a testament to the significance of this document in the realm of employment transparency and rights.

QuestionAnswer
Form NameForm LS-59
Form Length1 pages
Fillable?Yes
Fillable fields29
Avg. time to fill out6 min 7 sec
Other namesform ls59, ls59 new york, ls 59, fillable ls 59

Form Preview Example

1. Employer Information

Name:

Doing Business As (DBA) Name(s):

FEIN (optional):

Physical Address:

Mailing Address:

Phone:

2. Notice given:

At hiring

Before a change in pay rate(s), allowances claimed, or payday

Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law Notice for Exempt Employees

3.Employee’s pay rate(s): State if pay is based on an hourly, salary, day rate, piece rate, or other basis.

Employers may not pay a non-hourly rate to a non-exempt employee in the Hospitality Industry, except for commissioned salespeople.

4. Allowances taken:

None

 

 

 

 

Tips

 

per hour

 

Meals

 

 

per meal

 

Lodging

 

 

 

 

 

Other

 

 

 

 

 

5. Regular payday:

 

 

 

 

 

6. Pay is:

 

 

 

 

Weekly

 

 

 

 

Bi-weekly

 

 

 

 

Other:

 

 

 

 

 

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 received notice of my pay rate, overtime rate (if eligible), allowances, and designated payday. 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

Employee Signature

Date

Preparer Name and Title

The employee must receive a signed copy of this form. The employer must keep the original for 6 years.

LS 59 (02/15)

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