This government document is issued by Department of Labor for use in Georgia
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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://dol.georgia.gov/document/separation-notices/separation-notice-individual-interactive-dol-800/download&sa=U&ved=2ahUKEwiPu4D2jZeHAxXFnf0HHTFGAw84FBAWegQIABAB&usg=AOvVaw1ae4JgEHIHLNikPwusdw0u&fexp=72519171,72519168