[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-276890-105":53,"doc-detail-276890-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","employee-separation-notice-rev-10-2025-employee-and-supervisor-instructions","Employee Separation Notice - Rev 10-2025 - Employee and Supervisor Instructions","","Employee Separation Notice form used to document and process both voluntary and involuntary separations. It collects employee and job information, specifies the separation type and effective date, records reasons and (for transfers) new agency details, and includes re-employment recommendation and formal acceptance signatures. An employee exit notes section explains leave payout limits, transfer leave accrual rules, compensatory leave handling under FLSA and civil service rules, benefit and insurance end dates, retirement contribution refunds, and post-separation address update requirements for W-2 delivery.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/employee-separation-notice-rev-10-2025-employee-and-supervisor-instructions/276890/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/employee-separation-notice-rev-10-2025-employee-and-supervisor-instructions/276890.png","ImageObject",442,249,{"name":88,"@type":89},"Taylor Morgan","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-27","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":40},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What sections must be completed for voluntary versus involuntary separation?","Question",{"text":108,"@type":109},"Voluntary separation is completed by the employee in Section A, while involuntary separation is completed by the supervisor in Section B. Both specify the effective close-of-business date and relevant separation details.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What happens to annual leave when an employee separates?",{"text":113,"@type":109},"Annual leave payout is governed by applicable civil service and executive order rules and is paid as a lump sum up to a maximum of 300 hours, with repayment or reemployment conditions depending on whether the employee transfers to another state agency or remains out of service.",{"name":115,"@type":106,"acceptedAnswer":116},"How are benefits and retirement contributions handled after separation?",{"text":117,"@type":109},"Retirement contribution refunds can be requested by completing the Refund of Accumulated Contributions form, and health and life insurance coverage ends on the last day of the month of separation. Overpaid premiums are refunded through the final paycheck, and supplemental insurance must be handled directly with the vendor.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},276890,1789495914,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":40,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":9},1099523885336,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","This form must be completed, signed and submitted to Human Resources as soon as the supervisor has knowledge that an employee will be separating.  \nEmployee Name:   Personnel \\#:   Job Title:  \nOffice Name:  (Select One)  Division:    \nI. INDICATE TYPE OF SEPARATION – Complete either Section A. or B. as applicable  \nA. VOLUNTARY SEPARATION – To be completed by Employee  \nPlease accept this as notice of my intended separation effective close of business on   for the following reason:  \n Resignation (Please indicate reason):  Better Job/Other Industry  \n Insufficient Telework  NoTelework Option  \n Transfer to Another State Agency  \nPay Reasons Personal  \nReason Not Stated  \nShift/Locale/Housing To Attend School Work-Related  \n(Please indicate new agency information so that your transfer can be processed accurately):  \nName of New Agency:  New Job Title:    \nAppointment Type:  Classified  Unclassified  Job Appointment  \n Retirement  \nPlease provide your current contact information to ensure receipt of final separation paperwork and W-2.  \nPhone Number:   Email Address:   Address:   City:   State:   Zip Code:    \nEmployee Signature Date  \nB. INVOLUNTARY SEPARATION – To be completed by Supervisor  \nThe above listed employee is hereby separated effective close of business on    \nfor the following:  \n Separation from Probation  \nTermination of Temporary Appointment (WAE, Job Appointment, Unclassified)  \n Layoff (Please indicate type):  Death  \nPermanent Probational  \nII.  \nRE-EMPLOYMENT – To be completed by Supervisor  \nWould you recommend this employee for re-employment at a later date?  \nYes  \n No  \nIf “no,” please state why you would not recommend this employee for re-employment. (Not required.)  \nIII. ACCEPTANCE  \nIn accordance with Civil Service Rule 12.11, this separation has been hereby accepted by:  \nSupervisor’s Signature  \nAppointing Authority’s Signature  \nDate  \nEMPLOYEE EXIT NOTES  \nI. LEAVE  \nA. Annual Leave Payout: In accordance with Civil Service Rule 11.10 (for classified) and Executive Order JML 24-122 (for unclassified), separated employees (except those transferring to another State agency) shall be paid the value of their accrued annual leave in a lump sum, up to a maximum of 300 hours.  \nIf an annual leave payout is received, you must remain out of State service for the number of hours for which you were paid, or, repay the Department that re-employs you for the number of hours you were paid which exceeded the number of hours that transpired during your break from State service. This repayment provision does not apply if you are returning to work for the first time after retirement or if being rehired into a job appointment or non-leave earning position.  \nB. Transfer: If you are transferring to another State agency into a classified or unclassified, leave-earning position without a break in service, your annual and sick leave accruals shall be transferred to the gaining agency.  \nNote: Transferring employees will need to update their LEO verification email address if their work email address is changing. For example, DCE agency email is [John.Smith@la.gov](John.Smith@la.gov) and new agency email [is](is John.Smith2@la.gov. If John)[ ](is John.Smith2@la.gov. If John)[John.Smith2@la.gov](is John.Smith2@la.gov. If John)[. If John](is John.Smith2@la.gov. If John) needs to reset his LEO login password, the verification email will be sent to his DCE email address and not the new agency email address. This will require John to contact his new agency Human Resources Office to have them submit an OTS ticket to update the verification email in order to reset his LEO login password.  \nC. Compensatory Leave (K-Time) Payout:  \n1. Non-Exempt Employees: All unused compensatory leave earned by Non-Exempt employees atthe time and one-half (1 .5) and/or straight (1 .0) rate shall be paid out upon separation or transfer in accordance with the Fair Labor Standards Act (FLSA) and Civil Service Rule 21 . 12(b)(3) .  \n2. Exempt Emplo","cbCaiciEdfNxO1w2","https://ap.wps.com/l/cbCaiciEdfNxO1w2","pdf",1092884,"English","# Indicate type of separation\n## Voluntary separation - To be completed by employee\n## Involuntary separation - To be completed by supervisor\n# Re-employment recommendation\n# Acceptance and signatures\n# Employee exit notes\n## Leave\n## Benefits\n## Change of address","[{\"question\":\"What sections must be completed for voluntary versus involuntary separation?\",\"answer\":\"Voluntary separation is completed by the employee in Section A, while involuntary separation is completed by the supervisor in Section B. Both specify the effective close-of-business date and relevant separation details.\"},{\"question\":\"What happens to annual leave when an employee separates?\",\"answer\":\"Annual leave payout is governed by applicable civil service and executive order rules and is paid as a lump sum up to a maximum of 300 hours, with repayment or reemployment conditions depending on whether the employee transfers to another state agency or remains out of service.\"},{\"question\":\"How are benefits and retirement contributions handled after separation?\",\"answer\":\"Retirement contribution refunds can be requested by completing the Refund of Accumulated Contributions form, and health and life insurance coverage ends on the last day of the month of separation. Overpaid premiums are refunded through the final paycheck, and supplemental insurance must be handled directly with the vendor.\"}]","Employee Separation Notice - Rev 10-2025 - Employee and Supervisor Instructions | PDF"]