Free Tip Statement - Connecticut

Connecticut Department of Labor Wage & Workplace Standards Division Tip Statement
I hereby attest as a "Service Employee" (Section 31-62-E2(c), Mandatory order No. 8), that during pay period ending I have received gratuities amounting to at least $2.00 per day (part-time) or $10.00 per week (fulltime) and I acknowledge receipt of the amount of gratuities to exceed 31% of the minimum wage per hour credited by my employer as part of the minimum fair wage. Signed: Date:

Connecticut Department of Labor Wage & Workplace Standards Division Tip Statement
I hereby attest as a "Service Employee" (Section 31-62-E2(c), Mandatory order No. 8), that during pay period ending I have received gratuities amounting to at least $2.00 per day (part-time) or $10.00 per week (fulltime) and I acknowledge receipt of the amount of gratuities to exceed 31% of the minimum wage per hour credited by my employer as part of the minimum fair wage. Signed: Date:
Revised 1/09