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

    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

  • 4. Allowances takes: None

  • 5. Regular payday:

    Friday

  • 6. Pay is:

    Weekly

  • 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.

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

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  • The employee must receive a signed copy of this form. The employer must keep the original for 6 years.

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  • Should be Empty: