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The form collects identifying details, the last employment period, and the reason for separation (including lack of work or other circumstances). It also captures any payments made beyond the last day, whether the employee earned at least $3,500, and the average weekly wage. 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It also includes whether the employee earned at least $3,500 and the average weekly wage.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How should the employer indicate the reason for separation?",{"text":113,"@type":109},"If the reason is “LACK OF WORK,” the employer checks the corresponding box. If the reason is other than lack of work, the employer must fully and clearly describe the circumstances in the provided space or on a separate sheet if needed.",{"name":115,"@type":106,"acceptedAnswer":116},"What are the employer’s notice and compliance requirements?",{"text":117,"@type":109},"The form includes notice requirements tied to OCGA Section 34-8-190(c), requiring the employer to provide a properly executed document to the employee. 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NOTICE\n\n1.Employee's Name.                                                      2.SSN_                                    \na.State any other name(s)under which employee worked.                                                              \n3.Period of Last Employment:From                                        To                                          \n4.REASON FOR SEPARATION:  \na.LACK OF WORK □  \nb.If for other than lack of work,state fully and clearly the circumstances of the separation:-                                    \n5.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)  \n(type of payment)  in the amount of $___t\"for period from_                    to  \nDate above payment(s)was/willbe issued to employee                      \nIF EMPLOYEE RETIRED,furnish amount of retirement pay and what percentage of contributions were paid by the employer.          per month      %of contributions paid by employer  \n6.Did this employee earn at least $3,500.00 in your employ?YES □NO □If NO,how much?$_                        Average Weekly Wage                    \n\n| Employer's  \u003Cbr>Name______   |  |  | Ga.D.0.L.Account Number_  \u003Cbr>(Number shown on Employer's Quarterly Tax and Wage Report,  \u003Cbr>Form DOL-4.)   |\n| --- | --- | --- | --- |\n| Address_____  \u003Cbr>(Street or RFD)   |  |  | I CERTIFY that the above worker has been separated from work  \u003Cbr>and the information furnished hereon is true and correct.This  \u003Cbr>report has been handed to or mailed to the worker.   |\n| City___                    | __State_  \u003Cbr>ZIP Code   |  |  |\n| Employer's   |  |  |  |\n| Telephone No.________   |  |  |  |\n| (Area Code)  \u003Cbr>(Number)   |  |  | Signature of Official,Employee of the Employer  \u003Cbr>or authorized agent for the employer   |\n| NOTICE TO EMPLOYER   |  |  |  |\n| At the time of separation,you are required by the Employment   |  |  |  |\n| Security Law,OCGA Section 34-8-190(c),to provide the  \u003Cbr>employee with this document,properly executed,giving the   |  |  | Title of Person Signing   |\n|  |  |  |  |\n| reasons for separation.If you subsequently receive a request   |  |  |  |\n| for the same information ona DOL-1199FF,you may attach a copy   |  |  |  |\n| of this form(DOL-800)as a part of your response.   |  |  | Date Completed and Released to Employee   |\n| NOTICE TO EMPLOYEE   |  |  |  |\n| OCGA SECTION 34-8-190(c)OF THE EMPLOYMENT SECURITY LAW REQUIRES THAT YOU TAKE  \u003Cbr>THIS NOTICE TO THE GEORGIA DEPARTMENT OF LABOR CAREER CENTER IFYOU FILE A CLAIM  \u003Cbr>FOR UNEMPLOYMENT INSURANCE BENEFITS.   |  |  |  |\n|  |  |  |  |\n\n# INSTRUCTIONS TO EMPLOYER FOR COMPLETIONOF THIS SEPARATION NOTICE\n\nIn accordance with the Employment Security Law,OCGA Section 34-8-190(c)and Rules pursuant thereto,aSeparation Notice must be completed for each worker who leaves your employment,regardless of the reasonfor the separation.This notice shall be used where the employer-employee relationship is terminated and shallnot be used when partial (DOL-408)or mass separation(DOL-402)notices are filed.  \nltem 1.Enter employee's name as it appears on your records.If it is different from the name appearing on theemployee's Social Security Card,report both names.  \nItem 2.Enter the employee's Social Security Number.Verify for correctness.  \nItem 3.Enter the dates of employee's most recent work period.  \nItem 4.a.If the reason for separation is for \"LACK OF WORK,\"check box indicated.  \nb.If the reason for separation is OTHER THAN \"lack of work,\"give complete details about theseparation in space provided.If needed,add a separate sheet of paper.  \nltem 5.If any type payment,(i.e.Separation Pay,Wages-in-lieu of Notice,etc.)was made,indicate the typeof payment and the period for which payment was made beyond the last day.Give the date on which thepayment was/willbe issued to the employee.DO NOT include vacation pay or earned wages","cbCainwaG544cRfc","https://ap.wps.com/l/cbCainwaG544cRfc","pdf",42038,"English","# SEPARATION NOTICE\n## Fields to complete\n## Instructions to employer for completion","[{\"question\":\"What information must the employer provide on the Separation Notice?\",\"answer\":\"The employer must provide the employee’s name and SSN, dates of the most recent work period, reason for separation, and any payments made for specified periods beyond the last day. It also includes whether the employee earned at least $3,500 and the average weekly wage.\"},{\"question\":\"How should the employer indicate the reason for separation?\",\"answer\":\"If the reason is “LACK OF WORK,” the employer checks the corresponding box. If the reason is other than lack of work, the employer must fully and clearly describe the circumstances in the provided space or on a separate sheet if needed.\"},{\"question\":\"What are the employer’s notice and compliance requirements?\",\"answer\":\"The form includes notice requirements tied to OCGA Section 34-8-190(c), requiring the employer to provide a properly executed document to the employee. The instructions also state the form must be completed for each worker leaving employment and specify signing and dating requirements.\"}]","SEPARATION NOTICE - State of Georgia Department of Labor | PDF",1789495875]