Employee Release Waiver

EMPLOYEE RELEASE WAIVER

Employee Information

Position and Employment Details

Employment start date:    Final regular salary (annual or hourly):

Separation and Consideration

Effective Date of this Release: . Employee's last day of work (if different): .

In exchange for the promises and payments set forth herein, Company will provide the following consideration to Employee which Employee acknowledges is adequate consideration for the release below:

Continuation of benefits (if any): If checked, specify terms below.

Release of Claims

In consideration of the payments and other promises set forth in this Release, Employee, on behalf of Employee and Employee's heirs, executors, administrators, successors and assigns, knowingly and voluntarily releases and forever discharges the Company and its past and present parents, subsidiaries, affiliates, agents, directors, officers, employees and representatives (collectively, Released Parties) from any and all claims, demands, causes of action, suits, liabilities, obligations and damages of any kind or nature whatsoever, whether known or unknown, suspected or unsuspected, which Employee has or may have had up to the Effective Date of this Release, including but not limited to claims arising under federal, state or local statutes, common law, contract law, tort law, laws prohibiting discrimination or harassment, wage and hour laws, and any claims for costs, fees or penalties. Employee expressly waives rights to assert such claims in any forum except as expressly reserved below.

Exceptions: The release does not apply to (a) rights to vested benefits under any employee benefit plan as of the Effective Date; (b) claims that cannot be waived as a matter of law, such as workers' compensation or unemployment insurance claims; and (c) any rights or claims arising after the Effective Date.

Employee acknowledges that this Release is intended to be a full and final settlement of all disputes and potential claims through the Effective Date, and that Employee has had the opportunity to consider and negotiate the terms of this Release.

Age Discrimination (ADEA) Acknowledgment

If Employee is age 40 or older, federal law may require additional notice concerning the waiver of certain age discrimination claims. Please indicate below.

I am age 40 or older:

If age 40 or older, Employee acknowledges: Employee has been advised in writing to consult with an attorney prior to executing this Release; Employee is allowed a period of 21 days to consider this Release; Employee may revoke this Release within seven (7) days following execution by providing written notice to the Company; and the Release will not become effective until the revocation period has expired. Employee acknowledges understanding these rights if applicable.

Confidentiality and Non-Disparagement

Employee agrees to keep the terms, negotiations and amounts of this Release confidential and will not make any public or disparaging statements about the Released Parties, their officers, directors or employees, except as required by law or to obtain legal or tax advice. Employee further agrees to cooperate reasonably with the Company regarding transition matters as requested.

Return of Company Property

Employee shall return all Company property in Employee's possession, including but not limited to keys, access cards, equipment, documents, confidential information and electronic devices, no later than Employee's last day of work unless otherwise agreed in writing.

Tax Withholding and Benefits

All payments under this Release are subject to applicable tax withholdings and deductions. Employee is responsible for all taxes associated with payments received pursuant to this Release. Any change to benefit elections, including continuation of health benefits, will be processed in accordance with plan terms and applicable law.

Mutual Non-Admission; Governing Law

This Release does not constitute an admission of wrongdoing by any party. This Release shall be governed by and construed in accordance with the laws of the state where the Company is headquartered, without regard to conflict of law principles. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Employment History

Employer 1

Employer 2

Education

References

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-Will Employment: Nothing in this Release alters the at-will employment relationship (if any) between Employee and the Company, except as expressly set forth in a signed written agreement.

Equal Opportunity: The Company is an equal opportunity employer. This Release does not alter the Company's obligation to comply with federal, state and local employment laws.

Applicant Certification & Authorizations

I certify that the information I have provided in this form and in any accompanying documents is true, accurate and complete to the best of my knowledge. I authorize the Company to contact prior employers and references identified above for purposes of verifying my employment history and background. I further authorize the Company to conduct background checks, including criminal history, with my consent where required by law.

I certify:    I authorize prior employer contact:    I authorize background check:

Employee acknowledges that Employee has read and understands this Release and that Employee has had the opportunity to consult with counsel prior to signing.

Sign Now