[IMPORTANT
N OTE
A BOUT
T HIS
S AMPLE
A GREEMENT:
T his
s ample
a greement
i s
p rovided
f or
general
g uidance
o nly
a nd
d oes
n ot
c onstitute
a dvice
a bout
c ompliance
w ith
a pplicable
l aws.
Please
c onsult
w ith
a n
e mployment
a ttorney
o f
y our
c hoice
b efore
i mplementing
a ny
p ortion
o f
this
s ample
a greement.]
Voluntary
T ip-‐Pooling
A greement
The
f ollowing
t ip-‐pooling
g uidelines
a pply
t o
e ligible
e mployees
w ho
c hoose
t o
p articipate
i n
[EMPLOYER]’s
v oluntary
t ip-‐pooling
a rrangement.
Employees
w ho
d irectly
s erve
c ustomers
i n
t he
f ollowing
j ob
c lasses
a re
e ligible
t o
p articipate
i n
[EMPLOYER]’s
v oluntary
t ip
p ool:
[ LIST
P OSITIONS
–
e .g.,
w ait
s taff,
c ounter
p ersonnel
w ho
s erve
customers,
b us
s taff,
s ervice
b artenders,
b ellhops].
O nly
e mployees
w ho
c ontribute
t o
t he
t ip
p ool
arrangement
w ill
b e
c onsidered
p articipants
i n
t he
p ool.
N o
s upervisors
o r
m anagers
w ill
b e
e ligible
t o
receive
a ny
s hare
i n
t he
t ip
p ool.
[PROVIDE
D ETAILS
O F
E MPLOYER’S
T IP-‐POOLING
A RRANGEMENT.]
I t
i s
t he
p olicy
o f
[ EMPLOYER]
t o
comply
w ith
f ederal
a nd
s tate
l aws
r egarding
p ayment
o f
w ages
a nd
t ax-‐reporting
o f
t ips/gratuities.
T o
the
e xtent
a ny
p rovision
o f
t hese
t ip-‐pooling
g uidelines
c onflicts
w ith
f ederal
o r
s tate
l aw,
a pplicable
l aw
supersedes
t hese
g uidelines.
By
s igning
b elow,
I
a cknowledge
t hat
I
u nderstand
t hese
t ip-‐pooling
g uidelines
a nd
c hoose
t o
p articipate
in
[ EMPLOYER]’s
v oluntary
t ip-‐pooling
a rrangement.
If
I
h ave
a ny
q uestions
a bout
t he
t ip-‐pooling
a rrangement,
I
u nderstand
t hat
I
s hould
c ontact
[ TITLE].
I
also
u nderstand
t hat
i f
I
l ater
d ecide
I
d o
n ot
w ant
t o
c ontinue
p articipating
i n
t he
v oluntary
t ip-‐pooling
arrangement,
I
m ust
c ontact
[ TITLE]
t o
o pt
o ut
o f
t he
t ip
p ool.
____________________________________
Employee
N ame
_____________________________________
________________________
Employee
S ignature
Date