Claimant's Separation Statement
After a worker files for unemployment benefits, we send a Notice to Employer – Claimant’s Separation Statement (PDF, 277 KB) to former employers. You must review the worker's job separation information and provide more information as necessary.
If the worker quit (PDF, 226 KB), was fired (PDF, 292 KB), or was separated for a reason such as a leave of absence (PDF, 227 KB), please complete and return the form by the printed return date. Include all supporting documentation related to the job separation.
If you don't send your completed Separation Statement to us on time, we may pay unemployment benefits to the worker. You may not be eligible for relief from benefit charges.
Please note the term “lack of work" (PDF, 232 KB) used in the Separation Statement, means:
- The position was eliminated;
- There is no full-time work available;
- The assignment ended; or
- There are similar circumstances.
What we need from you | How we decide on worker benefits | Temporary layoffs and standby rules | Appeal an unemployment tax decision | Employer FAQs - benefit claims process | Employer FAQs - general | Contact information for employers