Form Dol-402a - Mass Separation Notice - List Of Workers - Georgia

ADVERTISEMENT

GEORGIA DEPARTMENT OF LABOR
MASS SEPARATION NOTICE - LIST OF WORKERS
Employer
Account Number
Severance Pay/Wages in Lieu of Notice (Paid or Being Paid)
Worker earned
Workers’ Names
Retired?
If yes, complete and indictate period if monies are for specified period.
$3,000 or more
(list alphabetically)
Social Security
No
Date
Avg. Gross
Lump Sum
Specified Period?
Number
Last
First
Middle
Amount
Yes
Paid
Amount
Weekly Wage
Yes
No
Yes
No
From
To
DOL-402A (R-11/01)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go