How to Complete and File Georgia Form DOL-800: Separation Notice

If you are looking for Georgia Form DOL-4N as a separation notice, the form you actually need is Form DOL-800. The Georgia Department of Labor uses DOL-800 as its current Separation Notice, and every employer in the state must complete one for each worker who leaves and deliver it to that worker.¹ The departing employee then takes it to a Department of Labor field service office when filing for unemployment insurance benefits.²

The number DOL-4N still circulates in older HR guides and templates, which is why the search leads here. Use DOL-800 instead, and pull it fresh from the state so you have the current revision.

Who Must Provide the Form and When

Under O.C.G.A. Section 34-8-190(c), every Georgia employer must complete a Separation Notice for each worker who leaves, no matter whether the person quit, was laid off, or was fired.² Georgia Department of Labor Rule 300-2-7-.06 sets the timing: the completed, signed form must be handed to the employee on the last day of work.³

If the worker is not there on the last day, whether because a shift ended early, the person did not show up, or the separation happened remotely, the employer must mail the notice to the worker’s last known address within three days of the date the separation occurred or became known.³ Keep proof of the mailing date.

One boundary to note: mass layoffs do not use the individual DOL-800. When 25 or more workers at a single location are separated on the same day for the same reason, the employer files Forms DOL-402 and DOL-402A with the Department of Labor instead.⁴

Where to Get the Current Form

Download the interactive PDF from the Georgia Department of Labor at dol.georgia.gov under “Separation Notices.”¹ The interactive version lets you type into the fields before printing, or you can print a blank copy and complete it by hand. The most recent revision is dated R-02-24. Pull it from the official site each time; outdated copies floating around online may be missing fields the Department of Labor now requires.

How to Complete Form DOL-800

The form has three main blocks: employee information, reason for separation, and employer information and signature.¹

Employee Information

Field 1, Employee’s Name: Enter the name as it appears on your payroll records. If that differs from the name on the employee’s Social Security card, report both.
Field 2, SSN: Enter the Social Security number and verify it against your records.
Field 3, Period of Last Employment: Enter the start and end dates of the employee’s most recent period of work with you.
Field 3a, Other Names: List any other names under which the employee worked for you.

Reason for Separation

Field 4 is the single most consequential part of the form. It offers two paths.

Field 4a, Lack of Work: Check this box if the separation was a layoff, a contract ending, or a position being eliminated. No further explanation is needed, and claims based on lack of work generally move through faster.
Field 4b, Other Than Lack of Work: For any other reason, including voluntary resignation, performance termination, policy violations, or misconduct, skip the checkbox and write a specific, factual explanation. Vague language like “not a good fit” invites follow-up and delays. Describe what happened, name the rule or policy involved, give the date of the incident, and note any prior warnings. Attach a separate sheet if you need more room.

Whatever you write in Field 4b becomes the Department of Labor’s starting point when deciding the claim. Detail protects both sides.

Wage and Payment Information

Field 5, Payments Beyond Last Day: Report severance pay, separation pay, wages in lieu of notice, bonuses, or profit-sharing the employee received or will receive. Do not include vacation pay or earned wages. Include the type of payment, the period it covers, and when it was or will be issued.
Field 6, Earnings Threshold: Check “Yes” or “No” to indicate whether the employee earned at least $9,490 during their time with you. If “No,” enter the actual amount earned.
Average Weekly Wage: Enter the employee’s average weekly wage at the time of separation, excluding overtime.
Retirement Information: If the employee retired, note the retirement pay amount and the percentage of contributions paid by the employer.

Employer Information and Signature

Employer’s Name: The full business name as it appears in your Georgia Department of Labor records.
Mailing Address: Where the Department of Labor should send communications about any resulting claim.
GA D.O.L. Account Number: Your eight-digit Georgia Department of Labor unemployment insurance account number, the same one that appears on your Quarterly Tax and Wage Report. A federal EIN or a payroll vendor’s internal number will not match your account.
Signature: An officer, employee, or authorized agent of the employer must sign and include their title. An unsigned DOL-800 does not count as a timely response to a claim.³
Date Completed and Released to Employee: The date you hand or mail the finished form to the departing worker.

Why the Reason for Separation Matters

Georgia law disqualifies claimants under specific circumstances, and the reason you write on the DOL-800 feeds directly into that analysis.⁵

Lack of work: A layoff or reduction in force carries no disqualification for the separation itself. The claim moves to the wage-eligibility stage.
Voluntary quit without good cause: An employee who left on their own is disqualified unless they can prove good cause connected to the work. The burden sits with the employee. Georgia recognizes two automatic good-cause exceptions: leaving to accompany a spouse reassigned between military assignments, and leaving due to documented family violence.
Discharge for cause: An employee fired for failing to follow rules or perform job duties is disqualified. More serious conduct carries higher requalification thresholds.

Because Field 4 drives this analysis, writing it carefully is not a formality. A specific, documented explanation gives the Department of Labor what it needs to decide the claim without pulling you into an extended fact-finding exchange.

What Happens If You Skip the Form or Submit It Wrong

If the worker already presented a properly completed DOL-800 when filing, the employer’s obligation to respond to the resulting claim is effectively satisfied, though the employer may still submit additional information if they choose.³

If the worker did not have a DOL-800, the Department of Labor sends the employer a “Notice of Claim Filed and Request for Separation Information” (Form DOL-1199FF or DOL-403FF) to collect the separation details.³ The employer must respond fully and on time. An unsigned or incomplete response is not treated as timely, which costs the employer the chance to contest the claim at the initial stage and can leave benefits charged to their unemployment insurance account.

From the employee’s side, a missing DOL-800 does not block a claim. The Department of Labor will still process the application and go to the employer directly for the separation information. Having the form in hand simply speeds things up, and the employee also needs to provide 18 months of work history when applying.⁶

Practical Tips

Most of the problems the Department of Labor sees on DOL-800 submissions come from a short list of avoidable mistakes.

Vague separation reasons. “Terminated” or “didn’t work out” in Field 4b tells the Department of Labor nothing. Name the specific event, the rule or policy involved, and whether warnings were issued.
Missing signatures. An unsigned form is treated as if it was never submitted. The signer needs actual authority and must include their title.
Wrong account number. Use the eight-digit Georgia D.O.L. account number from your Quarterly Tax and Wage Report, not your federal EIN or a payroll vendor’s number.¹
Late delivery. Hand the form over on the last day of work when you can. If you mail it, get it out within three days and keep proof of the mailing date.

Employers who handle separations regularly do best by keeping blank DOL-800 forms printed and on hand. The form is short enough to complete during an exit meeting, which is the cleanest way to meet the delivery requirement and avoid the three-day mailing clock entirely.

1
Georgia Department of Labor. Separation Notice Individual Interactive DOL-800
2
Justia Law. Georgia Code 34-8-190 – Requirements Governing Claims for Benefits
3
Georgia Secretary of State. Georgia Code 300-2-7 – Requirements for Employees and Employers – Section: Rule 300-2-7-.06 Notices Required From Employers Furnishing Separation Information
4
Georgia Department of Labor. Mass Separations
5
Justia Law. Georgia Code 34-8-194 – Grounds for Disqualification of Benefits
6
Georgia Department of Labor. Individuals FAQs – Unemployment Insurance