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Employment Separation Certificate

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Employment Separation Certificate

This document certifies employment information. Please read the information on page 2 before completing this form.

1. Employee details

Family name

First given name

Date of birth

Date employee started working for you

Date employment ceased

Address

Postcode

2. Reason for separation

Please give reason and/or further details

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?

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?

Provide details below
Type of leave Date paid/to be paid Gross amount $ Period covered (number of working days or weeks) Tax free portion Eligible Termination Payment (ETP) component Amount held for rollover Number of days employee worked per week
Redundancy
In lieu of notice not applicable not applicable
Gratuity or golden handshake not applicable not applicable
Sick Leave not applicable not applicable not applicable
Rostered days off not applicable not applicable not applicable
Annual Leave not applicable not applicable not applicable
Maternity Leave not applicable not applicable not applicable
Long Service Leave not applicable not applicable not applicable
Other

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

7. In the last 12 months, did this person cash in any leave entitlements for money before finishing work?

Provide details below
Type of leave Number of working days Amount $ (gross) Date paid/to be paid
Annual Leave (including leave loading)
Long Service Leave
Other

8. Employer details

Business/Trading name

Australian Business Number (ABN)

Address

Postcode

Phone number

Name and position held in organisation

Date

Signature of employer or representative

Employer’s stamp (if applicable)

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.

Former employees please see important information on the back of this form.

Information for Former Employees

If you do not have another job to go to and you want to claim a Centrelink payment you will need to:

• call Centrelink on 13 1021 to make an appointment

• visit your local Centrelink Office

• visit our website at www.centrelink.gov.au

The date of the first contact with Centrelink regarding your new claim is very important as it may be your first date of entitlement to a payment.

Note: Your payments may be delayed for the following reasons:

If you have been paid, or are entitled to be paid, a redundancy payment or leave entitlements such as annual leave, long service leave, sick leave or maternity leave, you may not be paid by Centrelink for a period equal to that covered by the leave payments that you received.

You may also have a waiting period depending on the amount of liquid assets (e.g. money, shares) you have available.

Remember: You should contact Centrelink as soon as possible once you cease employment.

Note: Calls to '13' numbers from a standard phone service can be made from anywhere within Australia for the cost of a local call. Calls to '18' numbers from public and mobile phones may be charged at a higher rate.

To speak to Centrelink in languages other than English, call 13 1202.

Information for Employers

What are Employment Separation Certificates?

Employment Separation Certificates are needed by Centrelink to enable a person to claim income support payments. You should provide a certificate to an employee if requested. The information contained in the Employment Separation Certificate is used to ensure that correct payments are made to customers.

This notice is given under either section 196 (if received from Centrelink) or 199 (if received from a former employee) of the Social Security (Administration) Act 1999 and allows a former employee or Centrelink to obtain this information.

Thank you for taking the time to fill in this form. We appreciate your co-operation in answering these questions and returning the form to the employee for return to Centrelink within 14 days of being given this form.

All the information contained in, or attached to, this report may be subject to release under the Freedom of Information Act 1982 (the FOI Act) to any person(s) (including those named in either the report or its attachments). If you want any of this information treated in confidence, please attach a statement indicating which information, and give your reasons. This will then be considered if a request is made under the FOI Act.

What exactly are Employment Separation Certificates used for?

They are used to ensure that only eligible people get paid an income support payment and that they are paid the right amount from the correct date. This means we have to know all of the information on the other side of this form, such as when the person ceased employment.

How can I get more Employment Separation Certificates?

• photocopy the Employment Separation Certificate on the other side and ensure that you place your stamp on the photocopy

• provide all the required information in a letter on your company letterhead

• call 1300 367 676 or 13 1158, to obtain further copies of this form

• print the copy of this form from Centrelink’s web site at www.centrelink.gov.au/internet/internet.nsf/businesses/emp_sep_cert.htm

How can I make enquiries about Employment Separation Certificates?

Centrelink provides a direct service to employers through its Business Hotline. The Hotline staff will answer any further questions you may have about the Employment Separation Certificate. The Centrelink Employer Hotline is also your first point of contact for any other information you may require about Centrelink in the future. The direct phone number to the Hotline is 13 1158 or fax 13 2115.

Superannuation Guarantee

Employers have obligations to pay superannuation for eligible employees and some contractors. For further information visit www.ato.gov.au or call the Australian Taxation Office on 13 10 20.

Definitions

Average gross weekly wage: This is usually contained in the industrial instrument that applies to that workplace (i.e. the appropriate award, workplace agreement or common law contract). Some workplaces include regular overtime and allowance as part of their average weekly wage.

ETP – Eligible Termination payment: Only certain payments paid to an employee on termination of employment are ETPs. These payments are taxed differently from other kinds of payments made on termination of employment.

Enter text✕

What an Employment Separation Certificate Is and When it’s Used

An Employment Separation Certificate documents the end of an employment relationship and summarizes key facts such as employment dates, reason for separation, final pay, and benefits status. Employers typically prepare it for payroll reconciliation, unemployment insurance claims, benefits administration, and personnel records. When issued electronically, the certificate can be executed under federal and state e-signature laws (ESIGN and UETA) so long as the signature method, consent, and record-retention requirements are satisfied.

Why a Clear Separation Record Matters

A well-completed Employment Separation Certificate reduces disputes, speeds unemployment and benefits processing, and creates a defensible record for audits or litigation. It helps payroll and HR teams reconcile final pay and tax reporting while providing former employees with formal documentation of employment termination.

Why a Clear Separation Record Matters

Who Prepares and Receives this Certificate

Typical creators and recipients of Employment Separation Certificates include internal HR, payroll teams, and former employees.

  • HR and Payroll — Prepare the certificate, confirm pay and benefits, and retain for records.
  • Former Employee — Receives formal documentation for unemployment claims and personal records.
  • State Agencies / Benefits Administrators — Use the certificate to verify eligibility and process claims.

The same document can be shared with government agencies and third-party benefits administrators as needed for claims and verification.

Core Elements to Include in a Professional Certificate

A complete Employment Separation Certificate contains standardized fields that make verification straightforward and reduce follow-up questions from former employees or agencies.

Employment Dates

Exact start and end dates listed as MM/DD/YYYY to verify duration and eligibility for benefits and to support tax and recordkeeping requirements.

Separation Reason

A concise reason (layoff, resignation, termination with cause, mutual agreement) that aligns with personnel records and supports unemployment determinations.

Final Pay Details

Final gross/net pay, date of last paycheck, and any severance amounts to reconcile payroll and support wage-based claims.

Benefits Status

State whether health, retirement, and accrued leave are continued, paid out, or terminated, and include relevant effective/expiration dates.

Employer Contact

Name, title, phone, and email of the HR contact who can verify the certificate or answer follow-up questions.

Signature Block

Signed and dated by an authorized representative; include electronic signature metadata or notary details if required for verification.

Step-by-Step: Preparing and Issuing the Certificate

Follow these sequential steps to create, approve, and deliver an Employment Separation Certificate with minimal delay.

  • 01
    Gather Records: Collect employment dates, payroll, benefits, and personnel file details.
  • 02
    Complete Form: Enter fields accurately using MM/DD/YYYY and standardized reason codes.
  • 03
    Authorize Signature: Have HR or authorized manager sign electronically or in ink as required.
  • 04
    Distribute and File: Send to employee and retain a copy in the personnel file with audit trail.

Where to Send the Certificate After Signing

Routing the certificate to the right recipients ensures claims and payroll matters are resolved quickly.

  • Employee Copy: Provide PDF or secure link to the former employee immediately.
  • Payroll System: Upload details to payroll for final pay reconciliation.
  • Benefits Administrator: Share benefits status with third-party administrators as needed.
  • State Agency: Supply to unemployment office or other government agency on request.

Typical Online Workflow Settings for Electronic Certificates

Configure these settings in your e-signature or HR system to control authentication, templates, and notifications for separation certificates.

Field Configuration
Template Use a locked template with required fields
Authentication Email link or SMS code verification
Notifications Auto-send to employee and HR inbox
Retention Store signed PDF and audit trail

Technical Requirements for eSubmission and Integration

Ensure your platform supports secure PDF output, audit trails, and integrations before deploying electronic certificates.

  • File Formats: PDF, DOCX supported
  • Integrations: Salesforce, NetSuite, Microsoft 365
  • Authentication: Email, SMS, or advanced options

Security and Compliance Checklist

Encryption: TLS 1.2/1.3 in transit
Data at Rest: AES-256 encryption
Certifications: SOC 2 Type II available
Healthcare: HIPAA compliant (BAA required)
Legal Framework: ESIGN and UETA compliant
Standards: ISO 27001 certified

Common Errors to Avoid When Preparing a Certificate

  • Using inconsistent names or abbreviations that do not match payroll or government records, causing verification delays.
  • Omitting exact employment end date or using ambiguous formats that lead to eligibility disputes for benefits.
  • Failing to record the authorized signer’s title and contact information, which lengthens agency follow-up and verification.
  • Sending unsecured attachments that expose personal data or violate privacy obligations for health or payroll information.

Consequences of Inaccurate or Late Certificates

Unemployment Disputes: Inaccurate records delay claims and increase appeals
1099 Penalties: IRC §6721: $60–$330 per form
I-9 Violations: I-9 penalties $281–$2,789 per violation
Privacy Fines: HIPAA breaches carry regulatory fines
Backup Withholding: Missing TINs can trigger 24% withholding
Litigation Risk: Poor documentation increases legal exposure

Timing and Delivery Expectations

Issue and deliver the Employment Separation Certificate promptly to avoid delays in claims, payroll, and benefits processing.

Issue at Separation:

Provide certificate on or before final paycheck issuance.

Employee Requests:

Respond promptly when a former employee requests a copy.

Agency Requests:

Supply records to state agencies within their requested timeframes.

Payroll Reconciliation:

Submit to payroll immediately to prevent tax/reporting errors.

Retain Signed Copy:

Keep a signed PDF and audit trail for recordkeeping.

Real-world Examples of Using Electronic Certificates

These examples illustrate how organizations streamline separation documentation and maintain compliance when issuing certificates electronically.

Optica Ventures — COO

Optica’s HR team centralized separation forms and e-signed them to speed closures and reduce paper handling.

  • The interface simplified employee delivery and recordkeeping.
  • The result was fewer follow-up requests and clearer audit trails while maintaining secure access for verification.

Martin Properties — Founder

Martin Properties moved separation notices online to close transactions faster and avoid in-person signatures.

  • Mobile signing enabled remote final pay processing.
  • The firm reported consistent document formatting and secure retention, easing landlord and contractor workflows that require formal termination proof.

How the Employment Separation Certificate Differs from a Separation Agreement

Compare the certificate with a negotiated separation agreement to choose the correct document for the situation.

Document Type Employment Separation Certificate Separation Agreement
Purpose record factual termination resolve claims or provide consideration
Legal Binding informational record contractually binding
Typical Contents dates, reason, pay payment terms, releases
When Used routine hr recordkeeping negotiated exit or settlement

eSignature Vendor Pricing Snapshot for Document Signing

Common vendor pricing and feature indicators to consider when choosing an e-signature platform for issuing Employment Separation Certificates.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions About Employment Separation Certificates

Answers to common questions about legal validity, required fields, e-signatures, and recordkeeping for Employment Separation Certificates.


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