Employee Leave Buyout

EMPLOYEE LEAVE BUYOUT AGREEMENT

Parties and Purpose

This Employee Leave Buyout Agreement (the Agreement) is made between Employer: and Employee: . The purpose of this Agreement is to set forth the terms under which the Employer will purchase accrued leave from the Employee in exchange for the payment described below.

Personal Information

Position Information

Start Date of Employment:   Current Annual Salary (or Hourly Rate):

Employment History (Most Recent Two Employers)

Education

Professional References (Three)

Leave Buyout Terms

Effective Date of Buyout: . Employee elects to sell accrued leave as set forth below.

Vacation / Paid Time Off    Sick Leave    Personal Leave

Gross Payment Amount:   Estimated Withholdings:   Expected Net Payment:

Tax Treatment and Withholding

Employee acknowledges that the gross buyout payment is subject to applicable federal, state and local income tax withholding and employment taxes as required by law. Employer will withhold taxes and report the payment on the appropriate wage reporting forms. Employee is responsible for any tax liabilities not satisfied by withholding.

Certification, Acknowledgements and Releases

Employee certifies that the accrued balance stated above is accurate and complete to the Employee's knowledge and that Employee has no other accrued leave claims beyond those disclosed in this Agreement. Employee authorizes Employer to deduct applicable taxes from the payment.

In consideration of the payment specified herein, and except as expressly reserved below, Employee hereby releases and forever discharges Employer from any and all claims, liabilities, obligations, demands and causes of action relating solely to the leave balances identified in this Agreement. This release does not waive Employee's rights to claims unrelated to accrued leave balances (for example workers' compensation claims, unemployment benefits, or other statutory rights that cannot be waived by agreement where such waiver is prohibited by law).

At-Will Employment / Equal Opportunity

Nothing in this Agreement alters the at-will nature of the employment relationship unless a separate written employment agreement expressly states otherwise. Employer is an equal opportunity employer and does not discriminate in employment on the basis of any protected characteristic. Employee acknowledges receipt of these statements.

Authorization and Background Acknowledgement

Employee authorizes Employer to verify employment history and references, and acknowledges that Employer may run background or payroll verifications as permitted by law in connection with benefit administration or recordkeeping. Employee acknowledges that such verifications are for administrative purposes and are not a condition precedent to this buyout unless required by Employer policy.

Governing Law, Entire Agreement, and Amendment

This Agreement shall be governed by and construed in accordance with the laws of the state applicable to the Employer's principal place of business. This Agreement contains the entire understanding between the parties concerning the subject matter and supersedes all prior agreements and understandings, whether written or oral. Any amendment must be in writing and signed by both parties.

Employee Certification

I certify that all information provided in this Agreement is true and complete. I voluntarily elect the buyout described herein, and I understand that my election is final and cancellable only as permitted by Employer policy or applicable law.

Administrative Use Only

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