77 separation notice 2026

1. Click ‘Get Form’ to open the 77 separation notice in the editor.
2. Begin by entering the worker's full name as it appears on your records in the designated field.
3. Input the worker's Social Security Number, ensuring to report any additional numbers in the explanation box below.
4. Fill in the dates: date separated, date hired, and date last worked using the mm/dd/ccyy format.
5. Select a reason for leaving from the provided options and provide further details in the explanation box as necessary.
6. Complete any relevant sections regarding vacation, severance, or other payments, ensuring not to use commas when entering dollar amounts.
7. Enter your name, title, and phone number as the person completing this form at the bottom of the document.
8. Finally, input your employer's name and address before clicking 'SUBMIT' to finalize your submission.

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