Rochester Pay Rate

Rochester Pay Rate Packet

Complete

Human Resources

Document Type

FROM

REPLY

example@example.com

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

CCHHS STAFF – IMPORTANT

Before completing this document/packet make sure the person’s name and DOB is the same as what is recorded in HHAeXchange.

Legal First Name Only. No nicknames, No Middle Names. No Middel Initials, No Abbreviations.

Legal Last Name Only: No nicknames, No Middle Names. No Middel Initials, No Abbreviations.

DOB: matches what is recorded in HHAeXchange.

I confirm I check the person's information and it matches what is recorded in HHAeXchange.*

I Confirm

First Name*

Last Name*

First Name*

Last Name*

Date of Birth*

Date

Select Your Department*

If you are a Personal Assistant (PA) for CDPAP select CDPAP above.

Select Your Branch*

1. Employer Information

Community Care Companions, Inc.

Doing Business as (DBA) Name (s):

Community Care Home Health Services

FEIN (optional)

Physical Address:
339 East Avenue
Rochester, NY 14604

Mailing Address:

300 W. Main Street
Smithtown, NY 11787

Phone: 631-549-9500

2. Notice given: At hiring

3. Employee’s rate(s) of pay for each type of work or shift:

$ $17.55 per hour Training and Shifts

Weekly hours ___40____ (Specify the number of hours for which the weekly rate or salary will be paid.)

Employers may not pay a non-hourly rate to a non-exempt employee in the Hospitality Industry, except for commissioned salespeople.

4. Allowances taken: None

5. Regular payday: Friday

6. Pay is: Weekly

7. Overtime Pay Rate(s) of pay for each type of work or shift: $ 26.33 per hour

This must be at least 1½ times the worker’s weighted average of the multiple rates of pay for the week, with few exceptions. The weighted average is the total egular pay divided by the total hours worked in the week. The overtime rate may ary from week to week depending on how many hours you worked at each rate of ay. The overtime rate may vary from week to week.

8. Employee Acknowledgement:

On this day, I have been notified of my pay rate, overtime rate (if eligible), allowances, and designated payday on the date given below. I told my employer what my primary language is.

I have been given this pay notice in English because it is my primary language.

Signature*

Date*

Date

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

Please note: It is unlawful for an employee to be paid less than an employee of the opposite sex for equal work. Employers also may not prohibit employees from discussing wages with their co-workers.

* You may also be assigned to work shifts with different pay rates. All pay rates will always be stated on your pay stub. You will be informed of the pay rate per shift when assignment is offered to you. You can always ask your coordinator to tell you the hourly shift before taking an assignment. The range reflected here is the minimum and maximum that you will be paid per hour.

CCHHS STAFF REVIEW – OFFICE USE ONLY

Staff Name*

Staff Title*

Staff Department*

Staff Completed Date*

Date