# Driver Pay Rate Notice: The Wage Notice States Require at Hire, for Hourly and Per-Trip Pay

Canonical URL: https://nemtguide.com/templates/driver-pay-rate-notice/ · Updated 2026-10-06

A wage notice is the written statement of pay terms that states such as California, New York, Minnesota, Connecticut, North Carolina, and the District of Columbia make an employer give each new hire. It names the pay basis, such as hourly or per trip, every rate, the overtime rate, the payday, and who the employer is. Most of these states also want written notice when pay changes.

- California, New York, Minnesota, Connecticut, North Carolina, and the District of Columbia require a written pay notice at hire, and other states may. Federal rules cover pay records, not a notice.
- Write per-trip pay as dollars per trip, and write separately how waiting time and time between trips are paid.
- California says a multiplier such as 1.5 is not an overtime rate. Write the dollar figure, or the minimum with a note that it can rise.
- A missing notice costs money: New York allows $50 for each workday up to $5,000, and Minnesota can fine up to $1,000 for each notice not kept on file.
- Written notice of a pay change comes before it takes effect in New York (7 days), Minnesota, and North Carolina (one pay period). California allows 7 days after.

A driver who does not know the rate for a wait at a dialysis clinic, or whether a cancelled trip pays, will find out on payday, and a state may then ask what you told the driver at hire. California, New York, Minnesota, Connecticut, North Carolina, and the District of Columbia all require the answers in writing at hire. This form gathers the items those laws ask for on one set of sheets, written for a driver paid by the hour, by the trip, or both.

## How to use this template

1. **Check your state first.** In California, New York, and Minnesota the state publishes its own notice. You may use your own form if it holds every required item, but the state's form is the surest way to cover each one. California's Labor Commissioner posts a template (DLSE-NTE, revised November 2023). New York's Department of Labor has LS 54 for one hourly rate, LS 55 for several hourly rates, and LS 57 for salary for varying hours, day rate, piece rate, flat rate, or other non-hourly pay. Minnesota's Department of Labor and Industry posts an example notice with the text in other languages that every Minnesota notice must carry. Fill in this form first, then copy the answers onto the state's form. California's template also asks whether a written agreement sets the rates, whether the employer is a staffing agency, and whether a state or federal emergency declaration covered the work county in the 30 days before the first day, so answer those on the state's form.
2. **Fill in Part 1 once,** and copy it to every notice. Fill in Parts 2 to 6 for each driver.
3. **Write each rate as dollars and the basis.** For per-trip pay, say what one trip is, such as one pickup to one drop-off, and how a cancelled trip or a no-show pays. Give every kind of pay its own line in Part 3. For which waits and drives you must count as work time, see [NEMT driver pay](https://nemtguide.com/guides/nemt-driver-pay/) and [NEMT driver overtime](https://nemtguide.com/guides/nemt-driver-overtime/).
4. **Hand it over before the first day of work.** You can give it with the [conditional offer letter](https://nemtguide.com/templates/conditional-offer-letter/), but as a separate page: California's Labor Commissioner says the notice must be on its own form.
5. **Get both signatures, give the driver a copy, and keep the original.** Put it in the driver's file with the papers on the [driver file checklist](https://nemtguide.com/templates/nemt-driver-file-checklist/).
6. **Use Part 7 for every change in pay.** Give the change in writing at the time your state requires, which the table below lists.

## The template

### Part 1: Employer

| Item | Fill in |
|---|---|
| Legal name of the employer, with Inc., LLC, or other ending | |
| Other names the company uses (doing business as) | |
| Physical address of the main office | |
| Mailing address, if different | |
| Telephone number | |
| Workers' compensation insurer: name, address, telephone, and policy number | |

### Part 2: Driver and job

| Item | Fill in |
|---|---|
| Driver's name | |
| First day of work | |
| Job title (driver, driver and dispatcher, attendant) | |
| Overtime status: eligible for overtime, or exempt and the legal reason | |
| Usual days and hours of work | |
| Language the driver reads best | |

### Part 3: How the driver is paid

Pay basis (circle every one that applies): hour, trip, day, week, mile, salary, other: ______________

| Kind of pay | Rate in dollars | Paid by (hour, trip, day, mile) | When it applies |
|---|---|---|---|
| Driving riders and driving between pickups | | | |
| Waiting with the van at a clinic or facility | | | |
| Time between trips, when the driver is not released | | | |
| Trip cancelled or rider a no-show | | | |
| Training, cleaning the van, office or dispatch work | | | |
| Night, weekend, or holiday pay | | | |
| Bonus or incentive pay, and what earns it | | | |
| Overtime: dollars per hour for hourly drivers, or how it is figured for trip pay | | | |

Attach a separate sheet for rates by level of service or route, and write "see attached sheet" in the first row.

### Part 4: Pay period and payday

| Item | Fill in |
|---|---|
| Pay period: weekly, every two weeks, or twice a month, and the number of days in it | |
| Regular payday: the day of the week or the days of the month | |
| Date of the first paycheck | |
| How and where the driver is paid (direct deposit, check at the office) | |

### Part 5: Allowances and deductions

| Item | Fill in |
|---|---|
| Allowances counted toward minimum wage: tips, meals, lodging (write "none" if none) | |
| Deductions that may be taken from pay: taxes, benefits, uniforms, advances, other (list each one) | |

### Part 6: Paid sick leave and other paid time off

| Item | Fill in |
|---|---|
| Paid sick leave: how it is earned, how many hours, and how to ask for it | |
| Vacation, holidays, or other paid time off: how it is earned and used | |
| Where the written policy is (handbook page or link) | |

### Part 7: Changes after the first notice

| Date notice given | What changed (old and new) | Date the change takes effect | Driver's initials |
|---|---|---|---|
| | | | |
| | | | |
| | | | |
| | | | |

### Part 8: Acknowledgment

On the date below I received this notice, and I told my employer the language I read best.

| | Driver | Employer's representative |
|---|---|---|
| Printed name | | |
| Signature | | |
| Date | | |

Copy given to the driver on (date): ______________ Driver refused to sign (yes or no): ______

## Which states require a written pay notice

As of October 2026, these five states and the District of Columbia each ask for the notice in writing. The table gives the rule and the law to look up:

| State and law | Notice at hire | When pay changes |
|---|---|---|
| California, Labor Code 2810.5 | At hire, no later than the start date. Not for overtime-exempt employees. | In writing within 7 days after, unless a timely wage statement shows it |
| New York, Labor Law 195 | At hire, in English and the driver's primary language when the state offers a form in it | In writing at least 7 calendar days before, unless the wage statement shows it |
| Minnesota, Statutes 181.032 | At the start of employment | In writing before the change takes effect |
| District of Columbia, Code 32-1008 | At hire, in English and the driver's language when the city offers a template | Within 30 days of the change |
| Connecticut, General Statutes 31-71f | At hire: pay, hours, and the pay schedule | Make changes in wage policies available in writing or on a posted notice |
| North Carolina, G.S. 95-25.13 | At hire: promised wages, and the day and place of payment | In writing at least one pay period before, except for a retroactive raise |

Other states may require a notice too, and cities can add their own rules. Look up your state labor department's page for employers before you hire. Federal rules do not hand the driver a notice. They ask you to keep, for each employee, the basis of pay, the regular rate in an overtime week, and the hours and wages for each pay period (29 CFR 516.2).

## What to write for per-trip and hourly pay

- **Dollars and a basis, not a description.** California's Labor Commissioner says a rate fixed by the hour, by the piece, or a mix must be written as money with the basis for earning it. On California's template, check Piece rate or Other and write "per trip". A per-trip rate is not an hourly rate, so New York's LS 57 (revised December 2025), the form for flat rate, piece rate, and other non-hourly pay, is the one that fits.
- **Every rate the driver can earn.** California says all rates that apply go on the notice, or on an attached sheet the notice points to. It accepts a sheet showing a range of rates when the notice states what sets each one, which fits trip rates that differ by wheelchair, stretcher, or distance.
- **Bonuses and add-ons, with what earns them.** Minnesota's labor department says a nighttime or weekend differential of $2 an hour needs no change notice each time a driver works a night shift if the first notice said it applies. Write night, weekend, holiday, and on-time pay into Part 3 up front.
- **An overtime rate, not just a multiplier.** California says stating 1.5 or double time does not specify an overtime rate. For hourly pay it wants a dollar figure. For drivers who also earn trip pay or bonuses, it accepts the minimum rate with a note that it rises when other pay is earned. New York's LS 57 says the regular rate is the week's total pay divided by the hours worked, and overtime is in most cases 1.5 times that rate.
- **Minnesota's extras.** Its notice must also say whether the driver is exempt from minimum wage and overtime and on what basis, list the deductions that may be taken, give the number of days in the pay period and the payday, and name the date of the first paycheck. Where the pay period varies, such as the 1st to the 15th and the 16th to month end, Minnesota's department says to state that the days vary, for example from 13 to 16, and name the paydays.
- **A regular payday, not just "biweekly".** California's Labor Commissioner wants the regular days, such as the 1st and 15th, or every Friday, as well as how often.
- **Paid sick leave.** California's template (revised November 2023) has its own paid sick leave section, and Minnesota requires the paid time off accrual and terms of use. Part 6 covers both. The state rules are in [paid sick leave laws by state](https://nemtguide.com/guides/nemt-driver-sick-leave/).

California also has pay-stub rules for per-trip pay, summarized in [NEMT driver pay](https://nemtguide.com/guides/nemt-driver-pay/).

## Language, signatures, and how long to keep it

- **California.** Give the notice in the language you normally use with the driver. The signature is optional: if the driver will not sign, hand over the notice and note the refusal on your copy. You can give it electronically if the driver can acknowledge receipt and print it. A driver cannot waive the notice, and the Labor Commissioner says to keep a record of each one given (FAQ revised March 11, 2016).
- **New York.** Give it in English and the driver's primary language when the Department of Labor offers a translation. The Department's LS 57 page lists 16 languages besides English as of October 2026. The driver signs and dates an acknowledgment, and you keep it 6 years. LS 54 and LS 57 say the driver gets a signed copy and the employer keeps the original.
- **Minnesota.** Give it in English with the commissioner's text telling the driver they may request another language, and give it in that language when asked. Keep a copy signed by the driver. Emailing the notice alone does not meet the signature rule, but an electronic signature does. A change notice needs no signature. Notices and written changes are records you keep 3 years (Statutes 177.30).
- **District of Columbia.** Give it in English, and in the driver's language when the city offers a template in it and you know the language or the driver asks. Keep signed and dated copies, or electronic proof the driver acknowledged it.

## What a missing notice costs

- **New York.** If a driver gets no notice within 10 business days of the first day of work, the driver can recover $50 for each workday the violation continues, up to $5,000, plus costs and attorney's fees (Labor Law 198, subdivision 1-b, revision of May 16, 2025). The law gives employers two defenses: they paid all wages due completely and on time, or they reasonably believed in good faith the notice was not required.
- **Minnesota.** The signed notice is a record you must keep. The commissioner may fine up to $1,000 for each record missing and up to $5,000 for each repeat (Statutes 177.30), and can order you to comply with the notice rule and pay the remedies in Statutes 177.27, according to the department's wage theft Q&A.
- **District of Columbia.** If you do not give the notice, that counts as evidence against your credibility about the rate of pay you promised. The three years a driver has to sue for unpaid wages also does not begin until you give the written notice and every itemized pay statement (Code 32-1008 and 32-1308).

Before you print a notice, check its rates against the [driver timesheet](https://nemtguide.com/templates/nemt-driver-timesheet/) you will use to record hours, and read [how to hire NEMT drivers](https://nemtguide.com/guides/hire-nemt-drivers/) for the rest of the hiring file.

## Frequently asked questions

### Does federal law require a wage notice for drivers?

The federal rule that covers pay information, 29 CFR 516.2, is a records rule, not a notice to the driver. It has you keep each employee's basis of pay (per hour, per day, per week, per piece, or other), the regular hourly rate in any week with overtime, hours worked each day and week, and the wages paid each pay period. Payroll records stay at least 3 years and rate tables 2 years (29 CFR 516.5 and 516.6). The notice comes from state law.

### Which states require a written pay notice at hire?

As of October 2026, five states and the District of Columbia are covered on this page: California (Labor Code 2810.5), New York (Labor Law 195), Minnesota (Statutes 181.032), Connecticut (General Statutes 31-71f), the District of Columbia (Code 32-1008), and North Carolina (G.S. 95-25.13). Other states may have their own rules, and cities can add more, so check your state labor department before you hire.

### Do I need a new notice when I give a driver a raise?

Usually some written notice, and the timing differs. California's Labor Commissioner says a raise needs no new notice when the new rate shows on the next wage statement. New York wants written notice at least 7 calendar days before a change, unless the wage statement shows it. Minnesota wants it in writing before the change takes effect, with no signature needed. The District of Columbia allows 30 days after.

### How do I show per-trip pay on a wage notice?

Write the dollars and the basis, for example $___ per one-way trip, and list every other rate the driver can earn: waiting time, time between trips, night or weekend pay, and any bonus with what earns it. California's Labor Commissioner says pay includes all rates fixed or worked out by calculation, and New York has its own form for piece rate, day rate, and other non-hourly pay (LS 57).

### What if a driver does not read English or will not sign?

In California, give the notice in the language you normally use with the driver, and if the driver refuses to sign, hand it over anyway and note the refusal on your copy. New York wants English plus the driver's primary language when the state offers a translation. Minnesota wants English with a statement that the driver may ask for another language, and a signed copy for your file.

### How long do I keep a signed pay notice?

New York says to keep the original 6 years (form LS 54, revised 12/25). In Minnesota the signed notice and every written change are records you keep 3 years, in a place where the driver works or that you can reach within 72 hours (Statutes 177.30). The District of Columbia wants signed and dated copies, or electronic proof the driver acknowledged it, as your proof of compliance.

## Official resources

- [California Labor Commissioner: Notice to Employee template (Labor Code 2810.5)](https://www.dir.ca.gov/dlse/LC_2810.5_Notice.pdf)
- [New York State Department of Labor: Pay rate notices and translations](https://dol.ny.gov/notice-pay-rate)
- [Minnesota Department of Labor and Industry: Example employee wage notice and translations](https://www.dli.mn.gov/employee-notice)