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Form 60-0154 - Notice Form Of Separation Or Refusal Of Work Under Conditions That May Disqualify - Iowa Workforce Development Page 2

OWA WORKFORCE DEVELOPMENT

P.O. Box 10331

Des Moines, Iowa 50306

INSTRUCTIONS

TO EMPLOYER

Whenever a worker leaves or refuses your

employment for any reason that you believe

disqualifies the individual from receiving

unemployment insurance benefits, you should

notify IOWA WORKFORCE DEVELOPMENT by

completing this Notice of Separation form,

60-0154.

THE ORIGINAL COPY of this form must be

postmarked or received by Iowa Workforce

Development within ten days of the date of the

worker’s separation. You may keep a duplicate

copy of the form for your file.

DO NOT use this form if the worker was laid off

for lack of work, regardless of whether the work

was permanent or temporary.

IF A WORKER FILES an unemployment

insurance claim, you will receive notice of that

filing by a Notice of Claim or through the

scheduling of a fact-finding interview with you and

the claimant.

IF A CLAIM FOR UNEMPLOYMENT INSURANCE

IS FILED, IOWA WORKFORCE DEVELOPMENT

will schedule a fact-finding interview and take the

statements from both the worker and the employer.

A decision will then be made regarding the

worker’s eligibility for unemployment insurance

benefits.

Form 60-0154 - Notice Form Of Separation Or Refusal Of Work Under Conditions That May Disqualify - Iowa Workforce Development Page 2