Form LS 59 at a glance
What it is: LS 59 is the Notice and Acknowledgement of Pay Rate and Payday under Section 195.1 of the New York State Labor Law, the Notice for Exempt Employees.
Where and when to file: The employee must receive a signed copy of this form. The employer must keep the original for 6 years.
A filled-in Form LS 59 example: a new weekly salaried hire
How to fill out Form LS 59, box by box
Employer Information
Under 1. Employer Information, enter the Name, Doing Business As (DBA) Name(s), FEIN (optional), Physical Address, Mailing Address and Phone.
Notice given
For 2. Notice given: At hiring, Before a change in pay rate(s), allowances claimed or payday.
Employee's pay rate(s)
In 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.
Allowances taken
Under 4. Allowances taken: None, Tips (per hour), Meals (per meal), Lodging, Other.
Regular payday and Pay is
In 5. Regular payday, enter the payday. In 6. Pay is: Weekly, Bi-weekly, Other.
Overtime Pay Rate
In 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.
Optional: enter the exemption under which this employee is exempt from overtime.
Employee Acknowledgement
In 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 only because it is my primary language. Or check: 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.
The lines are Print Employee Name, Employee Signature, Date, and Preparer Name and Title.
More rules for Form LS 59
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.
Sources
[1] Form LS 59 (12/25), Notice and Acknowledgement of Pay Rate and Payday, New York State Department of Labor (the Official source link on this page).