Notice of Employee Separation Form Instructions

To submit this form, mail the completed form to TALX Employer Services, PO Box 1160, Columbus, OH 43216. Alternatively, you can send it via direct fax to 1(866) 848-0100. Ensure all required fields are completed, and the form is signed before submission. For additional inquiries, you can contact the submission office via email.

Important dates for this form in 2024 and 2025 include the employee's first and last working days as well as the separation date. Ensure that these dates are accurately recorded.

The Notice of Employee Separation form serves the purpose of accurately reporting an employee's separation from a company. This form documents the reason for separation, the employee's job details, and any remuneration paid after separation. Properly filling out this form ensures compliance with employment regulations and accurate record-keeping. Employers use this form to detail the circumstances surrounding an employee's departure, whether due to resignation, termination, or other reasons. By providing accurate and comprehensive information, this form helps maintain transparency and accountability in the employee separation process. Additionally, it assists HR departments in managing records, ensuring that all necessary details are documented for future reference. In summary, the purpose of this form is to provide a structured method for reporting employee separations, aiding in compliance, record-keeping, and effective HR management.

• 1. Employee Name: Full name of the employee being separated.
• 2. Social Security Number: Social Security Number of the employee being separated.
• 3. Job Title and Description: The job title and a brief description of the employee's role.
• 4. Reason for Separation: The reason for separation, selected from a predefined list of options.
• 5. First Day Worked: The first day the employee started working for the company.
• 6. Last Day Worked: The last day the employee worked for the company.
• 7. Remuneration Paid After Separation: Details of any remuneration paid to the employee after separation.
• 8. Remarks: Additional remarks or comments related to the separation.
• 9. Rate of Pay - Starting: The starting rate of pay for the employee.
• 10. Rate of Pay - Ending: The ending rate of pay for the employee.
• 11. Company Name: Name of the company reporting the employee separation.
• 12. Address: Address of the company.
• 13. City: City where the company is located.
• 14. State: State where the company is located.
• 15. ZIP: ZIP code for the company's address.
• 16. Location #: Location number of the company, if applicable.
• 17. Submitted By: Name of the person submitting the form.
• 18. Phone #: Contact phone number of the person submitting the form.
• 19. FAX #: Contact fax number of the person submitting the form.
• 20. E-MAIL ADDRESS: Email address of the person submitting the form.
• 21. Additional Remarks on 2nd Page: Any additional remarks provided on the second page of the form.

Failing to submit this form can lead to various issues and complications. It is crucial to ensure timely submission to avoid negative consequences.

• Non-compliance with Regulations: Failing to submit could result in non-compliance with employment regulations and potential legal issues.
• Inaccurate Records: Without submission, employer records may be incomplete or inaccurate, affecting payroll and HR processes.
• Potential Fines: Delayed or missing submissions might result in fines or penalties from regulatory bodies.

• 1. Employee Resignation: Document an employee's voluntary resignation from the company.
• 2. Termination: Report the termination of an employee due to disciplinary reasons or performance issues.
• 3. End of Assignment: Record the completion of a temporary or project-based assignment.
• 4. Retirement: Document an employee's retirement from the company.
• 5. Layoff: Report a layoff due to lack of work or reorganization within the company.