Notice Of Employee Separation Urgent
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1NOTICE 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 #: _______________________________________
ND
ADDITIONAL REMARKS ON 2
PAGE
SUBMITTED BY: ______________________________________
PHONE # _____________________________________________
FAX # _______________________________________________
E-MAIL ADDRESS ____________________________________
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