LS59s-HC-Final.docx - fordham 2026

1. Click ‘Get Form’ to open LS59s-HC-Final.docx in the editor.
2. Begin by filling out the Employer Information section. Enter the employer's name, DBA name, FEIN (if applicable), physical address, mailing address, and phone number.
3. In the Notice Given section, indicate whether the notice was provided at hiring or on or before February 1. Also, specify if it was given before any changes in pay rate or allowances.
4. For Employee’s Pay Rate(s), state whether the pay is hourly, salary, day rate, piece rate, or another basis. Ensure compliance with regulations regarding non-exempt employees.
5. Complete the Allowances Taken section by indicating any tips, meals, lodging, or other allowances applicable to the employee.
6. In the Employee Acknowledgement section, have the employee print their name and sign to confirm receipt of their pay information in both English and their primary language.
7. Specify the Regular Payday frequency (weekly, bi-weekly, or other) and fill in the Overtime Pay Rate as required by New York State law.
8. Finally, ensure that both parties sign and date the document. The employee should receive a signed copy while you retain the original for your records.

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