Restaurant tip pool distribution policy plus the FLSA §3(m) tip-credit notice required before an employer may claim a tip credit toward minimum wage.
⚠️ This is a blank template, not legal advice: check the wording with a lawyer and adapt it to your jurisdiction and your case.
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TIP POOLING POLICY AND TIP CREDIT NOTICE — effective
PART A — TIP POOLING POLICY
1. PARTICIPATION 1.1. The tip pool includes the following roles: . 1.2. Distribution formula: . 1.3. Pooled tips are distributed with each paycheck () 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: . 3.2. If a tip credit is taken: the cash wage paid directly by is per hour; the additional amount claimed as a tip credit toward minimum wage is 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 state before relying on this notice.
ACKNOWLEDGMENT I, , acknowledge that I have received and understand this Tip Pooling Policy and Tip Credit Notice.
Employee signature ______________ / / 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.
Documents that are usually drawn up in the same process.
Core employee handbook (at-will, EEO, anti-harassment, leave, discipline, social media, safety) plus a signed receipt acknowledgment — required in practice to be enforceable in court.
Written offer of employment covering position, pay, and benefits, with an at-will employment disclaimer — the de facto U.S. hiring standard.
Letter confirming the end of employment, final pay, benefits continuation, and return of company property — a separate formal separation notice is legally required in roughly 20 states.
2 of 10 fields are taken from the company, employee or counterparty record, the questionnaire can be dictated to the AI, and the finished document comes with a number, a PDF and an acknowledgement record.