Employee Release Forms

EMPLOYEE RELEASE AND SEPARATION AGREEMENT

Personal Information

Position Information

Reporting Manager:

Original Start Date:    Separation Date:

Employment History (Most Recent)

Employment History (Previous)

Education

Graduation Date:

References

Legal Disclosures and Acknowledgements

At-Will Employment: Employee acknowledges that, except as expressly provided in a written agreement signed by an authorized representative of Employer, employment is at-will and may be terminated by either party at any time, with or without cause.

Equal Opportunity: Employer reaffirms its commitment to equal employment opportunity. This Agreement does not alter Employer's obligation to comply with applicable nondiscrimination laws.

Release Terms

General Release of Claims: In exchange for the consideration set forth below, Employee fully and forever releases and discharges Employer, its parent, subsidiaries, affiliates, predecessors, successors, assigns, and each of their officers, directors, employees and agents (collectively, Released Parties) from any and all claims, demands, causes of action, suits, liabilities, costs, expenses, and damages of any nature whether known or unknown, suspected or unsuspected, that Employee has or may have against the Released Parties through the Effective Date of this Agreement, except for obligations arising under this Agreement and those that cannot be waived by law (such as vested benefits under ERISA plans and claims for unemployment compensation and workers' compensation).

Consideration Offered: Employer agrees to provide the following consideration to Employee in exchange for the release above: Severance Payment: $ (gross), Payment of accrued but unused paid time off: $ , and continuation of certain benefits as described by Employer. Employee acknowledges receipt of accurate information regarding consideration.

Acknowledgement of Voluntariness: Employee acknowledges that Employee has been given a reasonable period to consider this Agreement, that Employee is entering into this Agreement voluntarily, and that Employee has the right to consult with counsel prior to signing. Employee further acknowledges that Employer advised Employee to review any potentially applicable release of claims affecting statutory rights, which may include a limited revocation period where applicable.

No Admission of Liability: This Agreement is not an admission of liability or wrongdoing by any party and shall not be used as an admission in any proceeding, except to enforce its terms.

Confidentiality and Non-Disparagement: Employee agrees to keep the terms, amount and events giving rise to this Agreement confidential except as required by law. Employee further agrees not to make disparaging remarks about the Employer, its officers, directors, employees, or agents.

Cooperation: Employee agrees to cooperate, at Employer's reasonable request, with respect to any matters arising from Employee's employment or separation, including providing truthful information and testimony if required, provided that Employer will reimburse reasonable travel expenses.

Certifications and Authorizations

Applicant Certification: I certify that all information provided in this document is true and complete to the best of my knowledge. I understand that any false statements may be grounds for rescission of this Agreement or other legal remedies.

Authorization to Contact and Background Check: Employee authorizes Employer and its agents to contact former employers, references, and other third parties to verify employment and other information provided. Employee consents to background checks as permitted by law.

Tax and Payment Acknowledgement

Employee acknowledges that any payments described in this Agreement are subject to applicable tax withholdings and that Employer will report such payments as required by law.

Other Provisions

Governing Law: This Agreement will be governed by and construed in accordance with the laws of the state identified by Employer as the principal place of business, without regard to conflicts of law principles.

Severability: If any provision of this Agreement is found to be invalid or unenforceable, the remainder of the Agreement will remain in full force and effect.

Acknowledgement of Receipt

Employee acknowledges receipt of all information required by this Agreement and that Employee has been provided the opportunity to consult with an attorney prior to signing.

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