Louisiana Separation Form
FED2055
The Louisiana Workforce Commission requires that employers complete a Separation Notice Alleging Disqualification for each worker who leaves employment without good cause connected with his work, is discharged for misconduct connected with his work, or is unemployed because of a labor dispute.
This form includes spaces for information about the reason for leaving, as well as information about severance, vacation, dismissal, bonus, and holiday pay compensation.
In addition to the form itself, the Separation Notice contains detailed instructions for the employer about when and how they need to have the employees complete information, including information about the dates that the employee was working for the company, reason for leaving and more. Employees should receive a copy of all instructions and information pertaining to why the employee stopped working.
State Mandatory Updates
State Non-Mandatory Updates
Federal State Mandatory Updates
- 06/2023 - EEOC Know Your Rights: Workplace Discrimination is Illegal - Revised with new information related to the new Pregnant Workers Fairness Act (PWFA) effective June 27, 2023 and a new revision date.
- 05/2023 - Fair Labor Standards Act (FLSA) - Federal Minimum Wage - Revised the Nursing Mothers section of the poster with the PUMP for Nursing Mothers Act (PUMP Act) and more clarification on employer requirements to provide reasonable break time and accommodations for nursing employees.
- 10/2022 - EEOC Know Your Rights: Workplace Discrimination is Illegal - Revised to use plain language and bullet points to summarize the laws for employees. Added a QR code that links to instructions on how to file a charge of workplace discrimination. This new version replaces the old Equal Employment Opportunity is the law poster.
Federal State Non-Mandatory Updates
- 05/2023 - Family and Medical Leave Act (FMLA) - Revised with a new easy to read question and answer format and a new QR code to access more information.
- 05/2023 - - Revised with a new website and a new QR code for more information.
- 07/2016 - Fair Labor Standards Act (FLSA) - Federal Minimum Wage - Update includes new regulation revisions as of August 2016 which includes text regarding nursing mothers and overtime rules.
- 07/2016 - - Update includes new regulation revisions as of August 2016 which includes the removal of penalty amount up to $10,000 against violators and revised contact numbers.
- 05/2016 - - Minor update includes a new QR code and contact information.
- 05/2016 - - Update includes minor reformatting and slight changes of verbiage regarding the usage of FMLA.