Notice Of Employment Information Form - Seattle Office Of Labor Standards Page 2
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1
2Employee Payment Information
1. Rate or rates of pay (e.g. hourly wage or annual salary) _____________________________________________
2. Overtime eligibility – “Overtime eligible” means employers must pay 1.5x the regular rate of pay for hours
worked in excess of 40 hours in a workweek.
Overtime eligible
Not overtime eligible
3. Pay basis - check box
Hour
Week
Day
Commission (overtime eligible)
Piece rate
Commission (overtime exempt)
Non-discretionary Bonus
Salary (overtime eligible)
Discretionary Bonus
Salary (overtime exempt)
Shift
Other (please explain below)
Explanation: ____________________________________________________________________________
4. Regular Pay day_______________
__
5. Tip policy
All tips are paid to the specific employee serving the customer
Tip pooling
Other tip policy
None (not a tipped positon)
Explanation - Employers must provide explanation of any tip sharing, pooling or allocation policies:
____________________________
Good Faith Estimate - Seattle’s Secure Schedule Ordinance SMC 14.22
*Only required for hourly (i.e. overtime eligible) employees at large retail and food services establishments with
500+ employees worldwide (additional requirement for full service restaurants to have 40+ full-service restaurant
locations worldwide).
1. Median number of hours over the course of a year:
Year begins: __________ 1
st
Quarter: _______ 2
nd
Quarter: ______ 3
rd
Quarter: ______ 4
th
Quarter: ______
2. On-Call Shifts:
YES
NO
Protections against Retaliation
Employers are prohibited from taking adverse action (e.g. firing, demoting, and making threats to report
immigration status) against any person for exercising rights protected by Seattle Labor Standards.
Seattle
Office of Labor Standards
For more information contact Seattle Office of Labor Standards at
(206) 684-4500
or see
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