DSHS 14-438, Stop Work Completed Form Examples and Samples
Find a clear and detailed example of a filled DSHS 14-438, Stop Work form. Our sample guides you on how to correctly report the end of your employment to the Washington State DSHS, ensuring your benefits are updated accurately. See a practical sample to help you fill out your own form.
DSHS 14-438, Stop Work Form Example
How this form was filled:
This example shows how to complete the DSHS 14-438 Stop Work form to notify the Washington State Department of Social and Health Services about the end of employment. The form includes the client's identifying information, employer details, the last day of work, the reason for stopping, and information about the final paycheck.
Information used to fill out the document:
- Client Name: Jane A. Smith
- Client ID Number: 123456789
- Last Day of Work: 01/10/2026
- Employer's Name: The Daily Grind Cafe
- Employer's Address: 456 Coffee Bean Blvd, Olympia, WA 98501
- Reason for Stopping Work: Laid off due to business closure.
- Date of Final Paycheck: 01/17/2026
- Gross Amount of Final Paycheck: $650.00
- Signature: Jane A. Smith
- Date Signed: 01/18/2026
- Phone Number: (360) 555-0101
What this filled form sample shows:
- Clearly written client name and ID for accurate case identification.
- Specific dates for the last day of work and final paycheck.
- A clear and concise reason for stopping work (e.g., layoff).
- Complete employer information for verification.
- Correctly filled final paycheck amount to assist with benefit calculation.
- Properly signed and dated by the client.
Form specifications and details:
| Form Name: | DSHS 14-438, Stop Work |
| Issuing Agency: | Washington State Department of Social and Health Services (DSHS) |
| Use Case: | Individual reporting involuntary job loss (layoff) to DSHS. |
Created: February 25, 2026 06:22 PM
