Pw 12 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the employer information. Fill in the name, DBA name(s), FEIN (if applicable), physical address, mailing address, and phone number.
3. Indicate when the notice was given by selecting either 'At hiring' or 'Before a change in pay rate(s)'.
4. Fill out the employee’s rate(s) of pay for each type of work or shift. Enter the hourly rates and specify the corresponding work types.
5. If applicable, list any allowances taken such as tips, meals, lodging, or other. Specify amounts where necessary.
6. Specify the regular payday and select how often pay is issued: weekly, bi-weekly, or other.
7. Detail the overtime pay rates for each type of work or shift as required by law.
8. Finally, have the employee acknowledge receipt of this notice by printing their name, signing, and dating the form.

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