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Fillable Separation Notice, Form DOL-800 - Georgia.gov - ohrmd dhs

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State of Georgia Department of Labor SEPARATION NOTICE 1. Employee's Name a. State any other name(s) under which employee worked. 3. Period of Last Employment: From 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: To 2. S. S. No. 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 More

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DOL800

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OHRMD DHS GEORGIA

Fillable Separation Notice, Form DOL-800 - Georgia.gov - ohrmd dhs

Employee's Name. 2. S. S. No. Address. Employer's. Name. (Street or RFD). City. State Less

DOL800

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