Dol 402A Form PDF Details

In the state of Georgia, navigating the complexities of mass layoffs entails a comprehensive process involving documentation to ensure both employers and employees are aligned with the required legal and procedural guidelines. At the heart of this process is the DOL 402A form, a crucial document issued by the Georgia Department of Labor. This document, known as the "Mass Separation Notice - List of Workers," is a specialized form that employers must fill out when they find themselves in the position of conducting a mass separation or layoff. It encompasses various details such as the employer's account number, a list of the workers affected (sorted alphabetically), and critical financial information regarding each worker such as severance pay, wages in lieu of notice, whether the worker earned $3,500 or more, and specifics about retirement. Additionally, the form captures essential employee data including social security numbers, names, the total average gross pay, and whether the payment represents a lump sum or is allocated for a specified period. The completion and submission of the DOL-402A form are integral steps that facilitate a smoother transition for both businesses and employees during what can often be a challenging time, ensuring that all parties have transparent and accurate information at their disposal.

QuestionAnswer
Form NameDol 402A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform dol 402a, 402a department labor form, specified monies 402a, 402a labor 402 form

Form Preview Example

GEORGIA DEPARTMENT OF LABOR

MASS SEPARATION NOTICE - LIST OF WORKERS

Employer

 

 

 

 

 

 

 

 

Account Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Workers’ Names

 

Worker earned

Retired?

 

 

Severance Pay/Wages in Lieu of Notice (Paid or Being Paid)

 

 

 

 

(list alphabetically)

 

$3,500 or more

 

If yes, complete and indicate period if monies are for specified period.

 

 

 

 

 

 

 

 

 

Social Security

Last

First

Middle

 

No

 

 

Date

 

 

 

Avg. Gross

Lump Sum

Specified Period?

Number

Yes

Amount

Yes

No

Paid

 

 

Amount

Weekly Wage

Yes

No

From

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOL-402A (R-8/06)