EMPLOYEE RATE OF PAY AND PAY DAY NOTIFICATION FORM

EMPLOYEE RATE OF PAY AND PAY DAY NOTIFICATION FORM
Employer Name:
Sodexo, Inc. and Affiliated Companies
Employer Corporate Address:
9801 Washingtonian Blvd, Gaithersburg, MD 20878
Employer Phone Number:
877 729 7396
Employee Name:
Hire Date:
Position:
Hourly Employee: $_________/hour
or
Salaried Employee: $__________/week
Overtime Rate (if applicable)*: $_____________/hour (for hours over 40 in a work week)
Regular Pay Day (check one):
*
____
Weekly on _______________ (day of week)
____
Bi-weekly on _____________ (day of week)
For eligible non-exempt employees, overtime pay will be paid at one and one half times the regular
hourly rate of pay. For eligible employees working in a tipped position, overtime pay will be paid at
one and one half time the regular minimum wage subtracted by the applicable tip allowance. If you
work in more than one position at different rates of pay during the applicable pay period, your
overtime rate will be calculated at a weighted average between the two hourly rates worked
(subtracted by the applicable tip allowance multiplied by the number of hours worked at in the tipped
position, where relevant).
I acknowledge receipt of this notice detailing my rate of pay, my overtime rate of pay (if
applicable) and the designated pay day. I also acknowledge that I have identified my primary
language to Sodexo, and understand that, if my primary language is any language other than
English, I shall be provided another copy of this notice in my primary language once the
Commissioner of Labor issues a template of this form in that language.
Date:
[Signature]
[Print Name]
Note: The employee must receive a copy of this form. The original should be placed in the
employee’s personnel file.
Revised December 2014