Separation Notice For Ga PDF Details

It's important to be aware of the various forms that are available for download on the Georgia Department of Labor (GDoL) website. One such form is the Separation Notice For Ga Form, which employers in the state are required to use when terminating an employee. This document provides critical information about how the termination will proceed, and it must be given to the employee in person or via mail. Make sure you're familiar with all of the requirements before terminating someone's employment in Georgia.

You may find information about the type of form you would like to complete in the table. It can show you how much time it will need to finish separation notice for ga, what parts you will need to fill in, and so on.

Form NameSeparation Notice For Ga
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesga separation notice, separation notice, separation notice', separation letter

Form Preview Example

State of Georgia

Department of Labor



Employee's Name




2. SSN







a. State any other name(s) under which employee worked.













Period of Last Employment: From












b.If for other than lack of work, state fully and clearly the circumstances of the separation:

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)

in the amount of $for period fromto

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.

per month


% of contributions paid by employer


6. Did this employee earn at least $7,300.00 in your employ? YES


If NO, how much? $

Average Weekly Wage $

Employer's Name

Mailing Address






Zip Code






Telephone No.







(Area Code)






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.

GA D. O. L. Account Number

I CERTIFY that the above worker has been separated from work and the information furnished hereon is true and correct. This report has been handed to or mailed to the worker.

Signature of Official, Employee of the Employer

or authorized agent for the employer

Title of Person Signing

Date Completed and Released to Employee



Page 1 of 3



DOL-800 (R-7/21)



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 block YES or NO to indicate whether this employee earned at least $7,300.00 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 must be dated as of the date it is handed to the worker. If the employee is no longer available at the time employment ceases, mail this form (DOL-800) to the employee’s last known address and enter date the form is mailed.

OCGA Section 34-8-256(b)

PENALTY FOR OFFENSES BY EMPLOYERS. “Any employing unit or any officer or agent of an employing unit or any other person who knowingly makes a false statement or representation or who knowingly fails to disclose a material fact in order to prevent or reduce the payment of benefits to any individual entitled thereto or to avoid becoming or remaining subject to this chapter or to avoid or reduce any contribution or other payment required from an employing unit under this chapter or who willfully fails or refuses to make any such contributions or other payment or to furnish any reports required under this chapter or to produce or permit the inspection or copying of records as required under this chapter shall upon conviction be guilty of a misdemeanor and shall be punished by imprisonment not to exceed one year or fined not more than $1,000.00 or shall be subject to both such fine and imprisonment. Each such act shall constitute a separate offense.”

OCGA Section 34-8-122(a)

PRIVILEGED STATUS OF LETTERS, REPORTS, ETC., RELATING TO ADMINISTRATION OF CHAPTER. “All letters, reports, communications, or any other matters, either oral or written, from the employer or employee to each other or to the department or any of its agents, representatives, or employees, which letters, reports, or other communications shall have been written, sent, delivered, or made in connection with the requirements of the administration of this chapter, shall be absolutely privileged and shall not be made the subject matter or basis for any action for slander or libel in any court of the State of Georgia.”

Page 2 of 3

DOL-800 (R-7/21)



Unemployment Insurance (UI) benefits are available to workers who are unemployed and who meet the state UI eligibility laws. You may file a UI claim the first week that your employment stops or your work hours are reduced.

For assistance or more information about filing a UI claim visit the Georgia Department of Labor’s website at You will need to provide the following information in order for the state to process your claim:

Your legal name as it appears on your Social Security card

Social Security Number

Georgia Driver’s License, if applicable

Work authorization documents, if you are not a U.S. citizen

Bank’s routing number and your account number, if you want to receive your benefit payments via direct deposit

Work history information for the last 18 months, to include your separation notice, if provided by your employer You can file your claim online using any Internet accessible device. Follow these steps to file your claim online:

1.Go to

2.Select Apply for Unemployment Benefits.

3.Answer the questions completely.

4.Download and read the UI Claimant Handbook. Information in this handbook provides detailed instructions regarding the unemployment insurance (UI) program and the “Next Steps” to follow after submitting your claim.

5.Record your Confirmation Number. A confirmation email will be sent to the email address provided when completing the claim application. (If you do not receive a confirmation number, the application was not successfully completed. It remains on the system for 24 hours. Log in again and make sure you select FINISH to receive a confirmation number.)

If you have questions about the status of your claim, you can check the status of your claim online at by using My UI (Check My UI Claim Status).

For assistance, contact UI Customer Service at 1.877.709.8185 Monday–Friday, 8:00 a.m. – 4:30 p.m. EST or email Customer.

Page 3 of 3

DOL-800 (R-7/21)

How to Edit Separation Notice For Ga Online for Free

It is possible to complete the state of georgia separation notice document using this PDF editor. The following actions will enable you to instantly get your document ready.

Step 1: To get going, select the orange button "Get Form Now".

Step 2: You're now ready to enhance state of georgia separation notice. You possess many options with our multifunctional toolbar - you can add, erase, or alter the content material, highlight the specific sections, as well as perform other commands.

These sections are included in the PDF form you will be filling out.

stage 1 to filling out georgia separation notice

Enter the appropriate data in the area Employers Name, Mailing Address, GA D O L Account Number, I CERTIFY that the above worker, City, State, Zip Code, Employers Telephone No, Area Code, Number, NOTICE TO EMPLOYER At the time of, Signature of Official Employee of, Title of Person Signing, Date Completed and Released to, and NOTICE TO EMPLOYEE OCGA SECTION c.

Completing georgia separation notice step 2

Step 3: When you are done, select the "Done" button to transfer the PDF form.

Step 4: Generate copies of the document - it will help you refrain from forthcoming concerns. And don't get worried - we are not meant to disclose or check your details.

Watch Separation Notice For Ga Video Instruction

Please rate Separation Notice For Ga

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .