Navigating the complexities of employee separation in Georgia entails dealing with specific documentation put forth by the Georgia Department of Labor, notably the Mass Separation Notice, better known as form DOL-402. This document becomes necessary when an employer faces the unfortunate circumstance of separating 25 or more employees on the same day for the same reason. It requires a detailed account of the employer’s information, including the account number, contact details, and a meticulous reason for separation—be it a lack of work, leave of absence, furlough, or otherwise. Alongside form DOL-402, the Mass Separation-List of Workers form (DOL-402A) must also be filled, catering to each group of employees separated for distinct reasons. Prompt submission of these forms, preferably within 24 hours post-separation, is crucial. This ensures an efficient claims processing procedure, potentially sparing the employer from individual information requests related to the separated employees. Moreover, this documentation inquires into specifics such as the last day worked, any anticipated return, and details concerning retirement contributions, underscoring the breadth of information needed to manage mass separation events with due diligence.
| Question | Answer |
|---|---|
| Form Name | Dol 402 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dol402 dol 402 formpdffillercom |
GEORGIA DEPARTMENT OF LABOR - MASS SEPARATION NOTICE
148 Andrew Young International Blvd., N.E., Suite 700
Atlanta, GA
Fax (404)
1. Employer |
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Account Number |
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Street Address |
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Telephone |
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INSTRUCTIONS
When 25 or more employees separate on the same day for the same reason, complete this form, IN DETAIL, and the Mass
Fax or mail this form and the List of Workers form to the above address/number within 24 hours after the date of separation. This will ensure that claims are handled efficiently and could eliminate requests to you for information on an individual basis.
2.Reason for separation (check one):
Totally separated because of lack of work.
Separated because of lack of work with or without a definite date to return to work.
Other reason (leave of absence with or without pay, furlough, etc.)
3. Last date worked |
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Year |
4. Date of expected return to work, if any.
5. Did any workers retire? Yes |
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No |
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Was any deduction made from the employee’s paycheck for retirement? Yes |
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No |
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If yes, what percentage of the entire retirement amount per pay period was paid by the employer? (Example: Employer paid 2% of salary into retirement fund; worker paid 2% of salary into retirement fund. Therefore, each paid 50%)
6.Address of work location, if different from above.
7.I certify that the information entered above and on all attached pages is true and correct.
Signature |
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