Download Job Separation Notice Template for Free

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NOTICE OF EMPLOYEE SEPARATION URGENT
Mail Immediately
The following employee was separated TODAY: Upon Separation of Any Employee
TALX Employer Services
(Name) PO Box 1160
Columbus, OH 43216
(Social Security Number)
DIRECT FAX: 1(866) 848-0100
(Job Title and Description)
First day worked
Rate of Pay: Starting
Wages Reported to State of
Last day worked
Rate of Pay: Ending
REASON FOR SEPARATION 04 - Discharge 05 - Vacation
(Check one and explain under remarks)
01 - Lack of Work
0400 No other information 0500 No other information
0401 Insubordination 0501 Scheduled vacation with pay
0100 No other information 0402 Violation of co. rules/policies 0502 Shutdown for vacation
0101 Reduction in force 0403 Violation of safety rules 0503 Shutdown for vacation, eligible for vac. pay
0102 Job eliminated 0404 Reported under influence alcohol 0504 Shutdown for vacation, eligible for partial
0103 Reorganization 0405 Reported under influence drugs vacation pay
0104 Completed Assignment: did not call avail.
0105 Completed Assignment: called in available
0106 End of temporary employment 0410 Destruction of co. property-willful
0107 End of seasonal employment 0411 Destruction of co.property-
08 - Retirement
0108 Project completed carelessness
0109 Casual 0412 Fighting on company property 0800 No other information
0111 Partially unemployed - reduced hours 0413 Leaving work station 0801 Voluntary-with pension (contributory)
0113 On call 0415 Falsification of emp. Application 0802 Voluntary-with pension (non-contributory)
0116 Temporary 0416 Dishonesty-falsified co. records 0803 Voluntary-without pension
0120 Plant closed 0417 Dishonesty-unauthorized removal 0806 Contractual-with pension (contributory)
02 - Not Separated
of company property 0807 Contractual-with pension (non-contributory)
0418 Dishonesty-monetary theft 0808 Contractual-without pension
0200 Not separated 0419 Dishonesty-other 0811 Involuntary-with pension (contributory)
0204 Disciplinary layoff 0425 Absenteeism-unreported 0812 Involuntary-with pension (non-contributory)
0211 Change in other employment 0426 Absenteeism-excessive and/or 0813 Involuntary-without pension
0214 Inclement weather unauthorized 0816 Disability-job related
03 - Quit
0428 Tardiness-frequent 0817 Disability-not job related
0300 Reason unknown 0431 Failed to maintain union status
0301 Abandoned job 0432 Excessive garnishments
06 - Labor Dispute
0302 Walked off job 0436 Quality of work
0303 Did not return from leave 0437 Quantity of work 0600 No other information
0304 Did not return from layoff 0438 Poor performance 0601 Member of striking union
0305 Personal-not job related 0439 Probationary-not qualified for job 0602 Refused to cross picket line
0306 School 0440 Poor judgment-no misconduct 0603 Strike-other union
0307 Marriage 0441 Lack of technical knowledge 0604 Company lockout
0308 Relocate 0451 Inability to work-illness 0605 Unsanctioned strike
0309 Family obligations 0452 Failure to pass physical
0310 Unable to obtain baby-sitter
90 - Miscellaneous
0311 Transportation
07 - Leave of Absence
0314 Continued Employment: New Owner 9000 No information whatsoever
0315 Accept another job 0700 No other information 9001 Refusal to work
0316 Go into own business 0701 Illness 9002 Change of status
0320 Illness 0702 Maternity 9003 Transfer to new location
0321 Maternity 0705 Injury-work connected 9099 Death
0326 Enter military 0706 Injury-not work connected
0330 Dissatisfaction-work hours 0710 Military
0331 Dissatisfaction-salary 0711 Family Obligations
0332 Dissatisfaction-working conditions 0712 Personal
0333 Dissatisfaction-performance review 0713 School
0334 Dissatisfaction-supervisor 0714 Other
0335 Dissatisfaction-company policies
0350 In Lieu of Discharge ( Protest)
0351 In Lieu of Discharge (No Protest)
REMARKS____________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
REMUNERATION PAID AFTER SEPARATION: COMPANY NAME _____________________________________
Pension $ _____________________
Vacation Pay $ _____________________________ ____Financed Wholly by Employer ADDRESS ____________________________________________
Allocated _____________________________ ____ In Part by Employer
Severance Pay $_____________________________ CITY, STATE, ZIP _____________________________________
Allocated _____________________________
LOCATION #: _______________________________________
ADDITIONAL REMARKS ON 2
ND
PAGE SUBMITTED BY: ______________________________________
PHONE # _____________________________________________
FAX # _______________________________________________
E-MAIL ADDRESS ____________________________________
Job Separation Notice Template
source: tools.cira.state.tx.us
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