Claimant separation statement: Fill out & sign online

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Click ‘Get Form’ to open the claimant separation statement in the editor.
Begin by entering the Claimant Name and Social Security Number (SSN) at the top of the form. Ensure accuracy as this information is crucial for processing.
Indicate whether the claimant was offered a job by selecting 'YES' or 'NO'. If 'YES', proceed to fill out all sections; if 'NO', complete only the certification section.
For a job offer, provide details such as the date the job was refused, reasons for refusal, and information about the person who made the offer including their title and contact number.
Fill in specifics about the job offered: title, duties, location, method of offer, pay rate, hours required, and expected duration. This information helps assess eligibility for benefits.
Complete the certification section by signing and dating it. Ensure that all provided information is correct to avoid penalties under Kansas Employment Security Law.

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