STATE OF TENNESSEE
DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
MASS SEPARATION NOTICE
(To be used only for lack of work separations)
Date _________________________, 20 _______ on _________________________, 20 _______
(date of notice)
(last day worked)
We permanently ceased to employ the following workers:
Social Security No.
Date Entered Employ
*If temporary separation give probable duration in “REMARKS” COLUMN.
All of above workers worked at
(where work performed)
Was separation caused by lack of work?
Employer Account Number _____________________________
By __________________________ Title ___________________
To be used only by arrangement with representatives of the Department of Labor and Workforce Development.