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 (full-time) and I acknowledge receipt of the amount of gratuities to exceed 29.3% 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 (full-time) and I acknowledge receipt of the amount of gratuities to exceed 29.3% of the minimum wage per hour credited by my employer as part of the minimum fair wage.Signed:
Date:
Revised 10/03
