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Employer Request For Waiver Of The Weekly Pay Requirement

THIS IS AN EMPLOYER REQUEST FOR A WAIVER OF THE WEEKLY PAY REQUIREMENT, CONNECTICUT STATUTE 31-71i.  IF YOU WISH TO USE IT TO REQUEST A WAIVER OF THE WEEKLY PAY REQUIREMENT, PLEASE COMPLETE THE ITEMS BELOW AND YOUR COMPANY WILL BE CONSIDERED FOR APPROVAL AND NOTIFIED BY MAIL.

In accordance with Connecticut General Statutes Section 31-71i the Labor Commissioner may grant a waiver of the weekly pay requirement.

NOTE:  This form is only available for employers requesting a bi-weekly pay.

(use the Tab key to move forward a field and Shift-Tab to move back a field)
Company/Corporation Name:
FEIN Number:
 
Street Address:
City:
State:    Zip Code: 
Telephone Number:
Method Of Pay:
 
Total Number Of Employees:
 
Number of Non-Exempt (hourly) Employees:
(if none, write "none")
 

 
Number of Exempt (salaried) Employees:
(if none, write "none")
 

 
Person Requesting Change:
 
Title Or Representative:
 
Address (where response should be mailed):
 
City:
 
State:
 		      Zip Code: 
Telephone Number:
 
E-Mail Address:

Additional Comments (if none, write "None"):


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