Fill and Sign the Against Employment Form

Release by Employee of Claims against Employer related to Terminated Employment Including the Release of Employee Benefit and Pension Plans and Funds Release Agreement made on and effective the ____ day of ________________________, 20____, between ______________________________________________ (Name of Employee) of ___________________________________________________________________________ ______________________________________________________________________________ ___________________________ (street address, city, county, state, zip code) , referred to herein as Releasor, and ______________________________________________ (Name of Employer), a corporation organized and existing under the laws of the state of ______________________________________, with its principal office located at ___________ ______________________________________________________________________________ __________________________________ (street address, city, county, state, zip code) , referred to herein as Company . Whereas, a certain contract of employment was entered into between Releasor and Company on _______________________________ (date) , and a copy of the contract is attached to as Exhibit A, and made a part of this Release; and Whereas, Releasor claims that Company has breached said contract and did wrongfully terminate him in the following ways: (describe facts claimed by employee as to breach of contract and wrongful termination) _______________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ __; Whereas, Company claims that it has not breached said contract and that Releasor was terminated for the following lawful reasons: (describe) _________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _; Whereas, Releasor is willing to release Company from all past and present claims based on said contract and said alleged wrongful termination on the terms set forth in this Release; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: I. In consideration of $ _____________ paid to Releasor by Company, receipt of which is acknowledged, Releasor, for (himself or herself) __________________ and (his or her) ______ heirs, legal representatives and assigns, releases and forever discharges Company, its partners, affiliated entities, successors and assigns, of and from all claims, demands, actions and causes of action of any kind or nature at law or in equity, based on the above-mentioned contract and/or said alleged wrongful termination. This Release applies to all past and existing claims, including, but not limited to, such rights of Releasor under the contract as (describe rights of employee/releasor, including basic compensation and fringe benefits) ___________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ __ . II. In consideration of the payments and benefits referred to in Section I above of this Agreement, Releasor, for (himself or herself) _______________________ and (his or her) ______________ heirs, legal representatives and assigns, releases and forever discharges Company, its partners, affiliated entities, successors and assigns, and any and all of its or their employee benefit and/or pension plans or funds, and any of its or their respective past or present partners, directors, agents, trustees, administrators, employees or assigns or members of the immediate family of any such person (whether acting as agents for such entities or in their individual capacities), hereinafter jointly and severely referred to as the Releasees , from any and all claims , demands, causes of action, fees and liabilities of any kind whatsoever (based upon any legal or equitable theory, whether contractual, common-law, statutory, federal, state, local or otherwise), whether known or unknown, which Releasor ever had, now has or may have against Releasees by reason of any actual or alleged act, omission, transaction, practice, conduct, occurrence, or other matter up to and including the effective date of this Agreement. III. Without limiting the generality of the foregoing Section II, this Agreement is intended to and shall release the Company and Releasees from any and all claims arising out of Releasor’s employment with Company and/or the termination of Releasor’s employment, including but not limited to: A. Any claim under the Age Discrimination in Employment Act, as amended, or the Older Workers Benefit Protection Act; B. Any claim under Title VII of the Civil Rights Act of 1964, as amended; C. Any claim under the Americans with Disabilities Act, as amended; D. Any claim under the Employee Retirement Income Security Act of 1974, as amended ( ERISA ) (excluding claims for accrued, vested benefits under any employee benefit plan of Company in accordance with the terms of such plan and applicable law); E. Any claim under the (Name of State) ___________________________________ human rights laws; F. Any other claim of discrimination or retaliation in employment (whether based on federal, state or local law, statutory or decisional); G. Any claim arising out of the terms and conditions of Releasor’s employment with Company , the termination of such employment, and/or any of the events relating directly or indirectly to or surrounding that termination; H. Any claim for breach of contract (express or implied), wrongful discharge, intentional or negligent misrepresentation, defamation, emotional distress or compensatory or punitive damages; and I. Any claim for attorney's fees, costs, disbursements and/or the like. IV. Releasor agrees not to commence, maintain, prosecute, or participate in any action or proceeding of any kind against any of the Releasees arising out of any act, omission, transaction, or occurrence occurring up to and including the effective date of this Agreement. Releasor further represents and warrants that (he/she) ____________ has not done so as of the effective date of this Agreement. If, notwithstanding the foregoing promises, Releasor violates this Section IV, ( he/she) _____________ shall indemnify and hold harmless Releasees from and against any and all demands, assessments, judgments, costs, damages, losses and liabilities, and attorney's fees and other expenses which result from, or are incident to, such violation. V. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. WITNESS our signatures as of the day and date first above stated. ____________________________________ (Name of Employer) ______________________________________ By_________________________________ ______________________________________ ____________________________________ (Name and Signature of Employee) (Name and Office in Corporation) STATE OF ______________________________________ COUNTY _______________________________ Personally appeared before me, the undersigned authority in and for said County and State, on this _____ day of _____________________________________, 20____, within my jurisdiction, the within named ______________________________________________ (Name of Officer), who acknowledged that he/she is the __________________________________ (e.g., President) of _____________________________________________________ (Name of Employer) , a ___________________________________________ (name of state) corporation, and that he/she executed the above and foregoing instrument for and on behalf of said corporation, after being duly authorized so to do. __________________________________________ NOTARY PUBLIC My Commission Expires: ______________________ STATE OF ____________________________________ COUNTY OF _________________________ Personally appeared before me, the undersigned authority in and for the said County and State, on this ______ day of ____________________________________, 20____, within my jurisdiction, the within - named _____________________________________________ (Name of Employee) , who acknowledged that he/she executed the above and foregoing instrument. __________________________________________ NOTARY PUBLIC My Commission Expires: ______________________ Note: (Form of acknowledgement/oath will vary from state to state)