Notice of Pay Rate and Payday (Xincon) (PA)

Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law
1. Employee Information

Name: Xincon Home Health Care Services, Inc.

Doing Business As (DBA) Name(s):

FEIN (Optional):

26-1301111

Physical Address:

224 W35th Street, Suite 708

New York, NY 10001

Mailing Address:

224 W35th Street, Suite 708

New York, NY 10001

Phone: 212-560-9218
2. Notice given:

At hiringBefore a change in pay rate(s),
3. Employee's rate of pay (per hour)
4. Allowances takes: None
5. Regular payday:

Friday
6. Pay is:

Weekly
7. Overtime Pay Rate:
Per hour(This must be at least 1.5 times the workers 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 only because it is my primary language.My primary language is (please enter below). I have been given this pay notice in English, because the Department of Labor does not yet offer a pay notice from my primary language.
Please enter your language here:
Print Employee Name
Employee Signature

Clear
times the worker’s regular rate with few exceptions
Date

MonthDayYear
Date
Preparer’s Name and Title
The employee must receive a signed copy of this form. The employer must keep the original for 6 years.
Should be Empty:

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