LS54 Pay Rate and Payday Notice

New York employers give this notice to hourly workers to tell them their pay rate, overtime rate and payday as the state labor law requires. It records employer details, the pay terms and the employee's signed acknowledgment.

Use this template

In the Claude connectors directory

Employer name

First Name

Last Name

Doing business as (DBA) names

FEIN (optional)

Physical address

Mailing address

Phone

2. Notice given

At hiring Before a change in pay

3. Employee's rate of pay

4. Allowances taken

5. Regular payday

6. Pay is

Weekly Bi-weekly Monthly Other

7. Overtime pay rate

Employee acknowledgment

Your primary language (if not English)

Check one

I received this notice in English because it is my primary language I received this notice in English and in my primary language My primary language has no official translation, so I received it in English

Employee name (print)

First Name

Last Name

Employee signature

Sign here

Date

Preparer's name and title

First Name

Last Name

Note for the employer

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