SEPARATION NOTICE - State of Georgia Department of Labor - DOL-800 (R-02-24)

Sep 15, 2026

This document is a Georgia Department of Labor Separation Notice form (DOL-800) used when the employer-employee relationship ends and a termination reason must be reported. It collects employee identity details, Social Security number, last employment dates, separation reason (including lack of work or other circumstances), and any payments made such as severance or wages-in-lieu of notice. Instructions explain employer completion requirements, verification steps, required notices, and applicable Georgia OCGA legal provisions and penalties.

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Separation Notice

Instructions to Employer for Completion

Notice Requirements and Legal References

in the to amount of $ for period from State of Georgia Department of Labor SEPARATION NOTICE 1. Employee's Name 2. SSN 6. Did this employee earn at least $9,490 .00 in your employ? YES NO If NO, how much? $ a. State any other name(s) under which employee worked. 4. REASON FOR SEPARATION: a. LACK OF WORK 3. Period of Last Employment: From ~~ ~~ To b. If for other than lack of work, state fully and clearly the circumstances of the separation: per month % of contributions paid by employer 5. Employee received payment for: (Severance Pay, Separation Pay, Wages-In-Lieu of Notice, bonus, profit sharing, etc.)(DO NOT include vacation pay or earned wages) (type of payment) Date above payment(s) was/will be issued to employee IF EMPLOYEE RETIRED, furnish amount of retirement pay and what percentage of contributions were paid by the employer. Average Weekly Wage $ | Employer's Name
Mailing Address
City State Zip Code
Employer's
Telephone No. ~~ ~~ ~~ ~~
(Area Code) (Number) | | --- | | | | At the time of separation, you are required by the Employment Security Law, OCGA Section 34-8-190(c), to provide the employee with this document, properly executed, giving the reasons for separation. If you subsequently receive a request for separation information, you may attach a copy of this form (DOL-800) as a part of your response. | NOTICE TO EMPLOYER NOTICE TO EMPLOYEE OCGA SECTION 34-8-190(c) OF THE EMPLOYMENT SECURITY LAW REQUIRES THAT YOU TAKE THIS NOTICE TO THE GEORGIA DEPARTMENT OF LABOR FIELD SERVICE OFFICE IF YOU FILE A CLAIM FOR UNEMPLOYMENT INSURANCE BENEFITS. Page 1 of 3 DOL-800 (R-02-24) INSTRUCTIONS TO EMPLOYER FOR COMPLETION OF THIS SEPARATION NOTICE In accordance with the Employment Security Law, OCGA Section 34-8-190(c) and Rules pursuant thereto, a Separation Notice must be completed for each worker who leaves your employment, regardless of the reason for the separation. This notice shall be used where the employer-employee relationship is terminated and shall not be used when employer-filed claims (partial) or mass separation (DOL-402) notices are filed. Item 1. Enter employee’s name as it appears on your records. If it is different from the name appearing on the employee’s Social Security Card, report both names. Item 2. Enter the employee’s Social Security Number. Verify for accuracy. Item 3. Enter the dates of employee’s most recent work period. Item 4. a. If the reason for separation is for “LACK OF WORK,” check box indicated. b. If the reason for separation is OTHER THAN “lack of work,” give complete details about the separation in space provided. If needed, add a separate sheet of paper. Item 5. If any type payment,(i.e. Separation Pay, Wages-in-lieu of Notice, etc.) was made, indicate the type of payment and the period for which payment was made beyond the last day. Give the date on which the payment was/will be issued to the employee. DO NOT include vacation pay or earned wages. Item 6. Check the appropriate blockYES or NO to indicate whether this employee earned at least $9,490 .00 in your employ. If you check NO, enter amount earned in your employ. Give average weekly wage (without overtime) at the time of separation. Employer’s Name. Give full name of employer under which the business is operated. Address. Give full mailing address of the employer where communications are to be sent regarding a potential claim. GA DOL Account Number Employer’s 8-digit state account number assigned by GDOL. Your state DOL Unemployment Insurance Account Number as it appears on your Quarterly Tax and Wage Report. Signature. This notice must be signed by an officer or employee of the employer or authorized agent for the employer, and this person’s title or position held with the employer must be shown. Date. This notice should be dated and delivered to the separated employee in electronic or hard copy format. OCGA Section 34-8-256(b) P

FAQs

What payments and wage information are required to report?

If any payment beyond the last day is made (such as severance or wages-in-lieu of notice), the type and period must be entered, along with the issue date. If the employee earned less than the stated threshold, the form requires the amount earned and the average weekly wage without overtime.

Sep 15, 2026

Uploaded by Maya Linwood