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Certificate of separation sample

Separation certificate sample 2026

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The document is an Employment Separation Certificate that certifies employment details for former employees, required by the Australian Government Department of Human Services to facilitate income support claims. It includes sections for employee information, reasons for separation, final payments, and employer details. The document emphasizes the protection of personal information and outlines the obligations of employers regarding superannuation and the provision of certificates.

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Click ‘Get Form’ to open the separation certificate sample in the editor.
Begin by filling out the 'Employee details' section. Enter the family name, first given name, date of birth, address, and employment dates accurately.
In the 'Reason for separation' section, select the appropriate reason from the provided options and provide any necessary details.
Indicate whether a claim for workers compensation has been made by selecting 'Yes' or 'No'.
Complete the financial details regarding final payments, including gross amounts for leave entitlements and redundancy payments.
Fill in employer details at the bottom of the form, including business name, address, phone number, and signature.

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