Employment Separation Certificate - Free Download
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Employment Separation Certificate
Employment Separation Certificate
SU001.1508
2. Reason for separation
Shortage of work
Unsuitability for this type of work
End of season or contract
Unsatisfactory work performance
Misconduct as an employee
Employee ceasing work voluntarily
Please give reason and/or further details
5. Did you pay (in the last 12 months), or will you pay the person, any unused
leave entitlements or final gross redundancy payments on termination
No Yes Provide details below
Other
Redundancy
7. In the last 12 months, did this person cash in any leave entitlements for
money before finishing work
8. Employer details
Business/Trading name
Address
Signature of employer
or representative
Name and position held in organisation
Date
Phone number
Employer’s stamp
(if applicable)
Postcode
6. If the person was paid a redundancy payment, in lieu of notice or gratuity,
what was the person's average gross weekly wage
(see page 2 – Definition)
$
per week
( )
No Yes Provide details below
This document certifies employment information. Please read the information on page 2 before completing this form.
1. Employee details (Former employees please see important information on the back of this form.)
Family name First given name
Date of birth
Date employee started working for you
Date employment ceased
Address
Postcode
Please note: Personal information is protected by law and can be given to someone else only in special circumstances, where Commonwealth legislation
requires or where you give permission. Giving false or misleading information is a serious offence.
Employment Separation Certificate
3. Has a claim been made, or is a claim likely to be made, for workers compensation
4. What was/is the person's final gross payment including leave and redundancy payments
No
Yes
$
5
7
Type of leave
Redundancy
In lieu of notice
Gratuity or golden handshake
Sick Leave
Rostered days off
Annual leave
Number of days
employee
worked per
week
Gross amount $
Amount held
for rollover
Tax free portion
Date paid/
to be paid
$$$$
$$
$$
$$
$$
not applicable
not applicable
not applicable
not applicable
Maternity Leave
Long Service Leave
Other
$$$
Eligibile
Termination
Payment (ETP)
component
$
$
$
$
$
$
$
$
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
day weekor
1 of 2
Australian Business Number (ABN)
Period covered
(number of
working days)
CLK0SU001 1508
Type of leave Number of working days Date paid/to be paidAmount $ (gross)
Annual Leave (including leave loading)
Long Service Leave
$
$
Other $
Instructions
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source: humanservices.gov.au
Employment Separation Certificate
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