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State of Georgia Department of LaborSEPARATION NOTICE 1. Employee's Name2. S. S. No.a. State any other name(s) under which employee worked. 3. Period of Last Employment: FromTo4. REASON FOR SEPARATION: a.

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Follow the steps to fill out the Fill Online form correctly.

  1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
  2. Begin by entering the employee's name in the designated field, ensuring it matches the records you have on file. If the employee has worked under a different name, please include that information as well.
  3. Input the employee’s Social Security Number accurately in the next field and verify its correctness.
  4. Indicate the period of the employee's last employment by filling out the 'From' and 'To' dates.
  5. For the reason for separation, check the box if it is due to 'LACK OF WORK.' If the separation is for another reason, provide a detailed explanation in the space allowed.
  6. Enter details regarding any payments the employee received, including types like severance pay or wages-in-lieu of notice. Specify the amounts and the relevant periods.
  7. Answer whether the employee earned at least $3,000.00 during their employment. If not, input the exact amount they earned and provide the average weekly wage.
  8. Fill in the employer’s name and address, making sure to provide the full mailing address for any communications.
  9. Input the Georgia DOL account number as shown on your Quarterly Tax and Wage Report.
  10. The form must be signed by an authorized individual, who should also include their title and the date the form is completed.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232