Sample - Job Abandonment Dismissal Page 3

premium information. Other health coverage options may be available to you, including

coverage through the Health Insurance Marketplace. Visit or call 1-800-

318-2596 for more information. [Make sure to provide the full COBRA notice to the employee

along with the other separation forms. More information, including model notices, is

available on the U.S. Department of Labor web site at

Sincerely,

[Appropriate Signature Authority]

c: Agency Personnel File

West Virginia Division of Personnel

[OPTIONAL LANGUAGE - If mailed via U. S. Postal Service, the following certification may be

typed at the bottom of the letter.]

The undersigned certifies that the above letter / notification was mailed to [name] by first-class

and certified mail, return receipt requested, on the __________day of ____________, 20_____.

[signature]_____________

[typed name and title]

[NOTE: Revised 6/2014. Ensure law, rule, and policy language is current.]

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Parent category: Letters