SOP_NUMBER: 104.62-att-1
TITLE: Separation Notice (GDOL-800)
REFERENCE_CODE: IVO18-0001
DIVISION: Administrative & Finance
TOPIC_AREA: 104 Policy-HR Payroll/Compensation/Salary
EFFECTIVE_DATE: 2018-07-10
WORD_COUNT: 535
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105306
URL: https://gps.press/sop-data/104.62-att-1/
SUMMARY:
This is the official Georgia Department of Labor Separation Notice form (GDOL-800) that GDC must provide to employees at the time of separation from employment. The form documents the reason for separation, any severance or separation payments issued, and employee wage information. Employers are required by OCGA Section 34-8-190(c) to complete and provide this form to the separating employee, who must present it to the Georgia Department of Labor if filing for unemployment insurance benefits.
KEY_TOPICS: separation notice, employee separation, unemployment insurance, GDOL-800, severance pay, separation pay, reason for separation, employment termination, wage information, unemployment benefits claim, employee discharge, layoff documentation
ATTACHMENTS:
1. Separation Notice (GDOL-800)
URL: https://gps.press/sop-data/104.62-att-1/
2. Instructions to Employer for Completion of Separation Notice
URL: https://gps.press/sop-data/104.62-att-2/
3. Employee Separation Reasons
URL: https://gps.press/sop-data/104.62-att-3/
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FULL TEXT:
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SOP 104.62
Attachment 1
7/10/18
1. Employee’s Name
State of Georgia
Department of Labor
**SEPARATION NOTICE**
2. S.S. No.
a. State any other name(s) under which employee worked.
3. Period of Last Employment: From To
4. REASON FOR SEPARATION:
a. LACK OF WORK
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)
In the amount of $ for the period from to
(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.
Per month % of contributions paid by employer.
6. Did the employee earn at least $3,000.00 in your employ? YES NO If NO, how much? $
Average Weekly Wage
|Employer’s
Name (Georgia Department of Corrections)
Address
(Street or RFD)
City State
ZIP Code
Employer’s
Telephone No.|Col2|Ga. D.O.L. Account Number 1 1 0 0 9 4 - 0 0
(Number shown on Employer’s Quarterly Tax and Wage Report,
Form DOL-4.)
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|
|---|---|---|
||||
|**NOTICE TO EMPLOYER**
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
the same information on a DOL-1199F, you may attach a copy of
this form (DOL-800) as a part of your response.|**NOTICE TO EMPLOYER**
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
the same information on a DOL-1199F, you may attach a copy of
this form (DOL-800) as a part of your response.|**NOTICE TO EMPLOYER**
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
the same information on a DOL-1199F, you may attach a copy of
this form (DOL-800) as a part of your response.|
|**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. **|**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. **|**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. **|
Retention Schedule: Upon completion, this form shall be retained permanently in the employee’s personnel file.