In the dynamic landscape of employment in New York, the Notice and Acknowledgement of Pay Rate form serves as a critical document for ensuring transparency and accountability between employers and employees. This form, established under Section 195.1 of the New York State Labor Law, is designed to provide clear communication concerning the crucial aspects of an employee's compensation package. It encompasses a variety of information including, but not limited to, the employee’s pay rate, allowances such as tips, meals, and lodging, the regular payday schedule, and the rate for overtime work. It is required at the time of hiring, and then again should any of those details change. Additionally, this form serves a dual purpose by allowing employees to acknowledge that they have received and understood this information, specifying their primary language and confirming the form's receipt in that language, if available. Employers are mandated to keep the original signed document for six years, underscoring the lasting importance of this acknowledgment in safeguarding employee rights. Moreover, the document includes a note about illegal wage disparities and restrictions on wage discussions among employees, reinforcing the state’s commitment to fair labor practices. This form thus not only facilitates a clear mutual understanding of employment terms but also embeds within it broader protections against discrimination and wage suppression.
| Question | Answer |
|---|---|
| Form Name | Ny Notice And Acknowledgement Of Pay Rate Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ls acknowledgement pay form, ls 54 2020, ls 54 form 2020, ls 54 |
Notice and Acknowledgement of Pay Rate and Payday/工资与发薪日通知与确认书
Under Section 195.1 of the New York State Labor Law/根据纽约州劳动法 (Labor Law) 第 195.1 条
Notice for Hourly Rate Employees/时薪员工通知
1. Employer Information/雇主信息
Name/名称：
Doing Business As (DBA) Name(s)/经营 (DBA) 名称：
FEIN (optional)/FEIN（选填）：
Physical Address/实际地址：
Mailing Address/邮寄地址：
Phone/电话：
2.Notice given/通知时间：
At hiring/聘用时
Before a change in pay rate(s), allowances claimed or payday/工资、补助或发薪日变化之前
3. Employee’s rate of pay/员工工资：
$per hour/每小时
4.Allowances taken/补助：
None/无 |
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Tips/小费 |
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per hour/每小时 |
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Meals/伙食 |
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per meal/每餐 |
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Lodging/住宿 |
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Other/其他 |
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5.Regular payday/固定发薪日：
6.Pay is/发薪周期：
Weekly/每周
Other/其他
7. Overtime Pay Rate/加班费：
$per hour (This must be at least 1½ times the worker’s regular rate with few exceptions.)/每小时 （必须至少为工人正常工资的 1.5 倍，少数例外。）
8. Employee Acknowledgement/员工确认：
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./本人于下方日期收到关于工资、加班 费（如有资格）、补助和指定发薪日的通知。本人已告诉 雇主本人的主要语言是什么。
Check one/请勾选一项：
I have been given this pay notice in English because it is my primary language./本人已收到此英语薪资通知， 因为英语是本人的主要语言。
My primary language is/本人的主要语言是 。
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./本人已收到此全 为英语的薪资通知，因为劳工署 (Department of Labor) 尚 未提供采用本人主要语言的薪资通知表。
Print Employee Name/正楷书写员工姓名
Employee Signature/员工签名
Date/日期
Preparer’s Name and Title/制表人姓名和职务
The employee must receive a signed copy of this form. The employer must keep the original for
6years./员工必须收到该表格的签名副本。雇主必须将原 件保存 6 年。
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
LS 54C (01/17)