Fillable Printable Employment Separation Certificate - Australia
Fillable Printable Employment Separation Certificate - Australia
Employment Separation Certificate - Australia
SU001.1501
2.Reason for separation
Shortage of work
Unsuitability for this type of work
End of season or contract
Unsatisfactory work performance
Misconduct as an employee
Employee ceasing work voluntarily
Please give reason and/or further details
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?
NoYesProvide details below
Other
Redundancy
7.In the last 12 months, did this person cash in any leave entitlements for
money before finishing work?
8.Employer details
Business/Trading name
Address
Signature of employer
or representative
Name and position held in organisation
Date
Phone number
Employer’s stamp
(if applicable)
Postcode
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
( )
NoYesProvide details below
This document certifies employment information. Please read the information on page 2 before completing this form.
1.Employee details (Former employees please see important information on the back of this form.)
Family nameFirst given name
Date of birth
Date employee started working for you
Date employment ceased
Address
Postcode
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.
Employment Separation Certificate
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?
No
Yes
$
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Australian Business Number (ABN)
CLK0SU001 1501
Type of leaveNumber of working daysDate paid/to be paidAmount $ (gross)
Annual Leave (including leave loading)
Long Service Leave
$
$
Other$
Type of leave
Redundancy
In lieu of notice
Gratuity or golden handshake
Sick Leave
Rostered days off
Annual leave
Number of days
employee worked
per week
Gross amount $
Amount held
for rollover
Tax free portion
Date paid/
to be paid
$$$$
$$
$$
$$
$$
not applicable
not applicable
not applicable
not applicable
Maternity Leave
Long Service Leave
Other
$$$
Eligibile
Termination
Payment (ETP)
component
$
$
$
$
$
$
$
$
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
Period covered
(number of working
days or weeks)
SU001.1501
(for Certificate, see page 1)
If you do not have another job to go to and you want to claim a Centrelink payment you will need to:
•go to our website
www.humanservices.gov.au or
•call our Employment Services Line on 132 850 or
•visit one of our Service Centres.
The date of the first contact with us 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 us as soon as possible once you cease employment.
To speak to us in languages other than English, call 131 202.
Note: Call charges apply – calls from mobile phones may be charged at a higher rate.
What are Employment Separation Certificates?
Employment Separation Certificates are needed by the Australian Government Department of Human Services 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 the Department of Human Services) or 199 (if received from a former employee)
of the
Social Security (Administration) Act 1999
and allows a former employee or the Department of Human Services 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 us within 14 days of being given this form.
However, your answers may be supplied to any person(s), (including those named in either the report or its attachments). If you do not want your
answers released please attach a statement explaining your reasons. If the department is considering release of the information you supplied, your
statement will be taken into account. The department may contact you further to discuss your concerns.
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?
If you need more you can:
•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 131 158, to obtain further copies of this form
•print the copy of this form from our website
www.humanservices.gov.au/forms
How can I make enquiries about Employment Separation Certificates?
Human Services provides a direct service to employers through its National Business Gateway. Our staff will answer any further questions you may
have about the Employment Separation Certificate.
The National Business Gateway is also your first point of contact for any other information you may require about us in the future.
The direct phone number to the National Business Gateway is 131 158 or fax 132 115.
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 131 020.
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– Employment Termination Payments: 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.
2 of 2
Employment Separation Certificate
Information for Employers
Information for Former Employees
