Employment Separation Certificate - Fill, Sign Online, Download & Print - No Signup
SU001.240228
Notes—
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Employment Separation Certificate
Business Hub
Returning this form
Employers can complete an Employment Separation Certificate online using Business Hub.
Go to
www.
servicesaustralia.gov.au/businesshub
Complete and return this form to the former employee or us
within 14 days
of receiving it.
Return this form and any supporting documents by post to:
Services Australia
Centrelink
Reply Paid 7800
CANBERRA BC ACT 2610
When to use this form
Use this form to provide information when requested by a former employee. We use this information to make
sure we pay customers the right amount from the correct date.
Important information
This notice is given under either section 196 (if received from Services Australia) or section 199 (if received
from a former employee) of the
Social Security (Administration) Act 1999
and allows a former employee or
Services Australia to obtain this information.
All the information contained in, or attached to the certificate may be released to any person under the
Freedom of Information Act 1982
. If you want any of this information treated in confidence, please attach a
statement indicating which information, and give your reasons. This will be considered if a request is made
under the
Freedom of Information Act 1982
.
For more information
If you have any questions about the Employment Separation Certificate or need help using the Business
Hub, call the National Business Gateway on
131 158
.
Go to
www.
servicesaustralia.gov.au/sepcertemployers
Information in your language
To speak to us in your language, call
131 202
.
Call charges may apply.
Hearing and speech assistance
If you have a hearing or speech impairment, you can use:
• the National Relay Service
1800 555 660
, or
• our TTY service on
1800 810 586
. You need a TTY phone to use this service.
For more information about help with communication, go to
servicesaustralia.gov.au
and search ‘other
support and advice’.
SU001.240228
Notes—
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Definitions
Long service leave
If the person was paid long service leave and worked full-time, please make sure you have marked the
appropriate box against a 5 or 7 day week in question 6.
Average gross weekly wage
This is usually contained in the industrial instrument that applies to that workplace (including the
appropriate award, workplace agreement or common law contract). Some workplaces include regular
overtime and allowance as part of their average weekly wage.
Employment Termination Payments (ETP)
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.
Information for former
employees
If you do not have another job to go to and you want to claim a Centrelink payment you need to either:
• go to
www.
servicesaustralia.gov.au/recentlyunemployed
• call our employment services line on
132 850
• visit one of our service centres.
Your claim will start the date you submit a completed claim form, including all documents required.
Did you receive a payment for a redundancy, annual leave, long service leave, sick leave or
parental leave?
If you did, there may be a waiting period before you can receive an income support payment. To avoid a
situation where you have no access to funds and no access to an income support payment, you should
contact us to find out how long your waiting period will be before you spend your termination payment.
You may also have a waiting period depending on the amount of liquid assets (for example, money, shares)
you have available.
You should contact us as soon as possible once you cease employment.
How to get more
Employment Separation
Certificates
To get more Employment Separation Certificates, you can:
• go to
www.
servicesaustralia.gov.au/forms
and print more copies
• photocopy the Employment Separation Certificate on the next pages and make sure you place your
stamp on the photocopy.
SU001.240228
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Employment Separation Certificate
(SU001)
1
Employee details
Family name
First given name
Date of birth (DD MM YYYY)
Address
Postcode
Postcode
2
Employer details
Business/Trading name
Address
Name of contact
Position held in organisation
Australian Business Number (ABN)
3
Employment details
Date employee started working for you
Date employment ceased
(DD MM YYYY)
(DD MM YYYY)
4
Reason for separation
Unsuitability for this type of work
End of season or contract
Redundancy
Shortage of work
Unsatisfactory work performance
Misconduct as an employee
Employee ceasing work voluntarily
Other
Please give
reason and/or
further details
below
5
What was/is the person’s final gross payment, including leave
and redundancy payments?
$
.
00
Contact phone number (including area code)
Filling in this form
You can fill this form digitally in some browsers, or you can open it
in Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader,
you can print this form and complete it.
If you have a printed form:
• Use black or blue pen.
• Print in BLOCK LETTERS.
• Do not use correction fluid or tape.
• Mark boxes
✔
CLK0SU001 240228
Instructions
Clear
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SU001.240228
Type of leave
Date paid/to be paid
Period covered
(number of
working days)
Gross amount
$
Number of days
employee worked
per week
Average gross weekly wage
$
Day
Month
Year
Redundancy
.
00
.
00
In lieu of notice
.
00
.
00
Gratuity or golden
handshake
.
00
.
00
Sick leave
.
00
Rostered days off
.
00
Annual leave
.
00
Parental leave
.
00
Long service leave
5
or
7
day week
.
00
Other
.
00
6
7
8
On termination, did you pay or will you pay the person any unused leave entitlements or final gross redundancy?
You need to read this
I declare that:
•
the information I have provided in this form is complete and correct.
I understand that:
•
giving false or misleading information is a serious offence.
No
Yes
Provide details below
Employer or
representative’s
full name
Privacy notice
Declaration
Privacy and your personal information
The privacy and security of your personal information is important to us, and is protected
by law. We collect this information to provide payments and services. We only share
your information with other parties where you have agreed, or where the law allows or
requires it. For more information, go to
www.
servicesaustralia.gov.au/privacypolicy
Date (DD MM YYYY)
Signature of employer
or representative
Employer’s stamp
(if applicable)
On completion of this form,
print and sign by hand
On completion of this form,
place your stamp here
