LS-54 Form PDF Details

Within the realm of employment, the dissemination of clear and concise information regarding the conditions of one’s employment is fundamental. One such avenue for ensuring that employees are fully informed about crucial aspects of their job is the LS 54 form, officially titled "Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law Notice for Hourly Rate Employees." This form encompasses a comprehensive outline of employment details that are pivotal for every worker to understand. It details the employer’s identity, including their primary and any doing-business-as names, along with contact information, ensuring transparency right from the outset. Furthermore, the LS 54 form mandates employers to inform employees about their pay rate, any allowances such as for meals or lodging, their regular payday, and the rate for overtime work. A significant component of this form is the section dedicated to employee acknowledgement. This section mandates that employees confirm their understanding and receipt of the information regarding their pay rate, overtime eligibility, allowances, and payday. Moreover, it addresses the necessity for employee notification in their primary language, a crucial aspect that underlines the emphasis on clear communication and understanding. The requirement for both the employee and employer to keep a copy of the form, with the employer retaining the original for a period of six years, underlines the legal importance of this document in maintaining clear records of the employment agreement.

QuestionAnswer
Form NameLS-54 Form
Form Length1 pages
Fillable?Yes
Fillable fields30
Avg. time to fill out6 min 19 sec
Other namesls54, ls 54 fillable, ls54 form, ls54 2021

Form Preview Example

1. Employer Information

Name:

College of Staten Island

Doing Business As (DBA) Name(s):

FEIN (optional):

13-1616880

Physical Address:

2800 Victory Blvd.

Staten Island, New York 10314

Mailing Address:

Phone: 718-982-2030

2.Notice given:

At hiring

Before a change in pay rate(s),

allowances claimed or payday

LS54(06/20)

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

3.Employee’s rate of pay:

$

 

per hour

4.Allowances taken:

None

□Tips

 

per hour

□Meals

 

per meal

□Lodging

 

 

□Other

 

 

 

 

5.Regular payday: Thursday

6.Pay is:

□ Weekly

Bi-weekly

□Other

7.Overtime Pay Rate:

$ N/A per hour (This must be at least 1 ½ 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 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

Sharon Christian, Associate Director

Preparer’s Name and Title

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

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