MN Written Wage Notice

MN Written Wage Notice
1. Employee Name:*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Date employment began:

MonthDayYear
Date
2. Legal name of employer:
Main office/principal place of business address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Operating name of employer (if different):
Mailing address (if different):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Employment Status (exempt or non-exempt):

Employee is exempt fromminimum wageovertimeother provisions of Minnesota Statutes 177Employee is non-exempt (entitled to overtime, minimum wage, other protections under Minn. Stat. 177)
Legal basis for exemption:
4. Rate or rates of pay Paid by:

HourShiftDayWeekSalaryPieceCommissionOther method
Is there a change to the rate of pay

YesNo
What is the rate of pay?
Overtime is owed afterblanks
Allowances claimed:
$blanks per meal for meal allowance (max = 60% of one hour of adult minimum wage per meal)
$blanks per day for lodging allowance (max = 75% of one hour of adult minimum wage per day) (or fair market value)
5. Leave benefits available:

Sick leavePaid vacationOther paid time off
How benefits are accrued: Number of hoursblanks or days .
per:

yearmonthpay periodhours worked
Terms of use:
6. Deductions that may be made from employee's pay and amounts:
7. Number of days in the pay period:
Regularly scheduled payday:
Date employee will receive first payment of wages earned:

MonthDayYear
Date
8. Other information relevant to this position:
I, the employee, have received a copy of this notice:

YesNo
Employer Signature*

Clear
Date

MonthDayYear
Date
Employee Signature

Clear
Date

MonthDayYear
Date
This document contains important information about your employment. Check the box below to receive this information in this language.

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Translation providers approved by the Minnesota Department of Administration

Betmar Languages, Inc.
6260 Hwy. 65 N.E.
Minneapolis, MN 55432
763-572-9711
best@betmar.com

The Bridge World Language Center, Inc.
110 Second Street S., #308
Waite Park, MN 56387
320-259-9239
mini@bridgelanguage.com

Fox Translation Services
1152 Mae Street, #122
Hummelstown, PA 17033
866-369-1646 or 407-733-3720
dina@foxfoxcasemanagement.com

Global Translation and
Interpreter
913 E. Franklin Ave., #206
Minneapolis, MN 55404
612-722-1244
sandor@globaltranslations.com

Latin American Translators Network, Inc.
1720 Peachtree Street N.W., #532
Atlanta, GA 30309
800-943-5286, ext. 8641, translations@latn.com
800-943-5286, ext. 8620, idenis@latn.com

Latitude Prime, LLC
80 S. Eighth Street, #900
Minneapolis, MN 55402
888-341-9080, ext. 501
elle@latitude.com

Lingualinx Language Solutions,
Inc.
433 River Street, #6001
Troy, NY 12180
518-388-9000
abartlett@lingualinx.com

Prisma International, Inc.
1128 Harmon Place, #310
Minneapolis, MN 55403
612-349-3111
jromano@prisma.com

Swits, LTD
110 S. Third Street
Delavan, WI 53115
262-740-2590
translations@swits.us
Should be Empty: