Employer Notification to Employees of the Availability of 
                     Unemployment Compensation 

Unemployment Insurance (UI) benefits are available to workers who are 
unemployed and who meet the requirements of state UI eligibility laws. You may 
file a UI claim in the first week that employment stops or work hours are reduced. 

For assistance or more information about filing a UI claim, 
call 1-844-224-5818 or visit www.jobs4tn.gov. 

You will need to provide the state UI agency with the following information in order 
for the state to process your claim: 

1. Your full legal name;
2. Your Social Security Number; and
3. Your authorization to work (if you are not a US Citizen or

resident. To file a UI claim by phone call: (844) 224-5818 

To file a UI claim online, visit: www.jobs4tn.gov 

If you have questions about the status of your UI claim, you can call the state UI 
agency at  1-844-224-5818 or email lwd.support@tn.gov.  

LB-0489 (Rev. 06-15)                                                               RDA 0063

                                                       STATE OF TENNESSEE
                                       DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT 
                                           DIVISION OF EMPLOYMENT SECURITY
                                         SEPARATION NOTICE

1. Employee's Name: ________________________________________________________  2. SSN _____________________
                      First             Middle Initial  Last
3. Last Employed: From: _______________ to _______________   Occupation: _____________________________________
                            (mm/dd/yyyy) (mm/dd/yyyy)
4. Where was work performed? _____________________________________________________________________________

5. Reason for Separation:                 Lack of Work               Discharge            Quit

If lack of work, indicate if layoff is     Permanent                  Temporary - Recall Date ______________
                                                                                             (mm/dd/yyyy)
If temporary, report any vacation pay that will be paid.    Week Ending Date _____________  Amount $ ______________
                                                                         (mm/dd/yyyy)
If layoff is indefinite vacation pay should not be reported.

6. Employee received:                     Wages in Lieu of Notice        Severance Pay

In the amount of $ _________________ for period from _________________ to _________________
                                                          (mm/dd/yyyy)   (mm/dd/yyyy)
If other than lack of work, explain the circumstances of this separation:

Employer's Name:

Address where additional information may be obtained:                     Employer's Telephone Number:

                                                                         Employer's Email Address:

                                                            Number shown on State Quarterly Wage Report (LB-0851) and 
Employer's Account Number:                                  Premium Report (LB-0456)

I certify that the above worker has been separated from work and the information furnished hereon is true and correct.  
This report has been handed to or mailed to the worker.
Signature of Official or Representative of the Employer     Title of Person Signing               Date Completed and 
who has first-hand knowledge of the separation                                                    Released to Employee

_________________________________________________________   _________________________             ____________________ 
                                                                                                          (mm/dd/yyyy)
                                           NOTICE TO EMPLOYER
Within 24 hours of the time of separation, you are required by Rule 0800-09-01-.02 of the Tennessee Employment Security Law 
to provide the employee with this document, properly executed, giving the reasons for separation.  If you subsequently receive a time 
sensitive request for separation information for the same information please give complete information in your response.

                                           NOTICE TO EMPLOYEE
YOU MAY BE INSTRUCTED TO MAIL OR FAX THE SEPARATION NOTICE TO TENNESSEE CLAIMS OPERATIONS IF YOU FILE A 
CLAIM FOR UNEMPLOYMENT INSURANCE BENEFITS.

LB-0489 (Rev. 06-15)                                                                                          RDA 0063

                                          STATE OF TENNESSEE
                       DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT

                                    INSTRUCTIONS 

                              SEPARATION NOTICES

Rule 0800-09-01-.02 of the Rules and Regulations of the Tennessee Employment Security Law, requires all 
employers to furnish each separated employee with a Separation Notice, LB-0489, within 24 hours of the 
employee's separation from employment.

Separation Notices do not have to be given to any employee who has been in your employ for less than a week 
or who will be recalled within seven days.

Separation Notices reduce the administrative costs of processing an unemployment insurance claim and helps 
make a more accurate determination of the claimant's eligibility for benefits.

Please complete the Separation Notice in its entirety.

Item 5

Check the appropriate block as to the reason the worker is separated.  If the separation was for any reason 
other than lack of work, give a clear explanation for the separation in the box provided.  Please indicate 
whether the separation is permanent or temporary, and, if temporary, when you expect to recall the worker.

Item 6
Wages in lieu of notice and severance pay affect UI

The Unemployment Insurance Accountability Act of 2012 denies unemployment insurance benefits to any 
claimant who is receiving or has received wages in lieu of notice equivalent to the wages he could have 
earned in that week had he been permitted to work during the period of notice. Wages in lieu of notice are 
wages paid under circumstances in which the employer did not give an advance notice of separation to the 
employee and are paid irrespective of the length of service of the employee.

UI benefits will also be denied to any claimant for any week in which he received a severance package that 
includes an equivalent amount of salary the employee would have received if he were working during that 
week.

Both the wages in lieu of notice and the severance provisions will not apply to claimants whose separating 
employer filed notice of a reduction in operations, in accordance with Tennessee Employment Security law, 
prior to July 1, 2012.

To obtain Separation Notice forms, please:

 Make copies of the form, or 

 Visit our website tn.gov/workforce

LB-0489 (Rev. 03/2020)                                                        RDA 0063