Tip Pooling Policy + Tip Credit Notice

TIP POOLING POLICY AND TIP CREDIT NOTICE ✓Establishment name — effective Policy effective date

PART A — TIP POOLING POLICY

1. PARTICIPATION 1.1. The tip pool includes the following roles: Tip pool participants. 1.2. Distribution formula: Distribution formula. 1.3. Pooled tips are distributed with each paycheck (Pay frequency) and are reported as wages on the employee's pay statement.

2. PROHIBITION ON MANAGER AND OWNER PARTICIPATION 2.1. Under the federal Fair Labor Standards Act, § 3(m), managers, supervisors, and owners may never keep any portion of employee tips or participate in a tip pool, even if they perform some tipped duties. Violations may result in repayment of tips plus liquidated damages and civil money penalties. 2.2. Where a tip credit is NOT taken, the tip pool may include back-of-house employees (e.g. cooks, dishwashers). Where a tip credit IS taken, the pool is limited to employees who customarily and regularly receive tips.

PART B — TIP CREDIT NOTICE (FLSA § 3(m)(2)(A))

3. NOTICE 3.1. Tip credit taken by employer: Tip credit taken?. 3.2. If a tip credit is taken: the cash wage paid directly by ✓Establishment name is Cash wage paid to tipped employees per hour; the additional amount claimed as a tip credit toward minimum wage is Tip credit amount claimed per hour. The tip credit claimed may not exceed the amount of tips actually received. 3.3. All tips received by an employee are the property of that employee, except for a valid tip pool described above. The employee has the right to retain all tips received, subject only to that valid pooling arrangement. 3.4. This notice must be provided before a tip credit is taken; providing it orally is legally sufficient but a signed written notice is the only reliably provable form in a wage dispute. 3.5. ⚠️ Minimum cash wage and tip-credit eligibility vary significantly by state; several states (including California, Washington, Oregon, Minnesota, Montana, Alaska, and Nevada) do not permit a tip credit at all. Verify current requirements for the ✓Establishment name state before relying on this notice.

ACKNOWLEDGMENT I, ✓Employee name (for notice acknowledgment), acknowledge that I have received and understand this Tip Pooling Policy and Tip Credit Notice.

Employee signature ______________ / ✓Employee name (for notice acknowledgment) / Date: Acknowledgment date

— — — ⚠️ This is a boilerplate template, not legal advice. Employment, consumer-protection, and business law in the United States vary significantly by state (and sometimes by city) — have this document reviewed and adapted by a licensed attorney in your state before use. Official government forms (Form I-9, Form W-4, Form W-9, Form 1099-NEC, etc.) are not included here and must be obtained directly from the IRS/USCIS in their official, unmodified form.