Employee Settlement Form

EMPLOYEE SETTLEMENT AGREEMENT AND RELEASE

This Employee Settlement Agreement and Release (the Agreement) is entered into by and between Employee Name: and Employer Name: . Effective Date: .

Personal Information

Position Information

Reporting Manager: Start Date: Current Annual Salary: $

Employment History (most recent)

Title: Dates Employed:

Title: Dates Employed:

Education

References

Settlement Terms

Consideration: In exchange for Employee's execution of this Agreement and the releases set forth below, Employer agrees to provide the payments and benefits described below (the Settlement Consideration).

Payment Form: Lump Sum Installments

Payment Schedule (itemize)

Tax Treatment and Withholding

Employee acknowledges and agrees that Employer will withhold applicable federal, state and local taxes and other legally required deductions from any payments made under this Agreement. Employer will report payments to the appropriate authorities in accordance with applicable law.

Benefits and Insurance

Employer agrees to provide continuation of health benefits as follows: . Employee understands any continuation is subject to plan terms and applicable deductions.

Return of Company Property

Employee represents that, except as disclosed below, all Employer property (including but not limited to keys, electronic devices, documents, records and access credentials) has been returned to Employer. Exceptions or items retained (if any):

Release and Waiver of Claims

In consideration of the Settlement Consideration, Employee hereby irrevocably releases and forever discharges Employer and its affiliates, predecessors, successors, officers, directors, employees and agents from any and all claims, demands, causes of action, liabilities, and damages of every nature, whether known or unknown, that Employee has, had, or may claim to have arising out of or relating to Employee's employment or separation from employment, through the Effective Date of this Agreement, including but not limited to claims under federal, state or local statutes, contract, tort, or common law. This release does not apply to rights or claims that cannot be waived by law.

Employee further represents that Employee has no pending charges or complaints with any governmental agency related to Employer, except:

Confidentiality and Non-Disparagement

Employee agrees to keep the terms and amount of this Agreement strictly confidential, except where disclosure is required by law or necessary for tax reporting or to obtain legal or financial advice. Employee also agrees not to make any statements, written or oral, that disparage Employer or its officers, directors, or employees. Employer agrees not to make any public statements that disparage Employee.

Cooperation and Future Assistance

Employee agrees to cooperate reasonably with Employer after the Effective Date in matters relating to pending litigation, investigations, or transactions, provided Employer reimburses Employee for reasonable expenses and schedules interviews at mutually agreeable times.

Legal Provisions

No Admission of Liability: The parties agree that this Agreement is a compromise of disputed claims and is not admission of liability by either party.

Governing Law and Venue: This Agreement will be governed by and construed in accordance with the substantive laws of the state identified below. Venue for any dispute arising out of this Agreement shall be the state or federal courts located in the county identified below.

Choice of Law State: County for Venue:

Entire Agreement; Severability: This Agreement constitutes the entire agreement between the parties regarding its subject matter. If any provision is found invalid, the remaining provisions will remain in full force and effect.

At-Will and Equal Opportunity Statements

At-Will Employment: Nothing in this Agreement alters the at-will nature of Employee's employment except as provided expressly in a separate, signed written document.

Equal Opportunity: Employer affirms that it is an equal opportunity employer and does not discriminate on the basis of any protected characteristic.

Applicant Certification and Authorizations

I certify that all information provided in this document is true and complete to the best of my knowledge and that I have disclosed all material facts relevant to my employment and separation. I authorize Employer to contact my previous employers and listed references for the purpose of verifying employment history and references in connection with matters related to this Agreement.

Authorization to Contact Previous Employers and Conduct Background Checks: I authorize contact I authorize background checks

Acknowledgment of Independent Advice

Employee acknowledges that Employee has been advised to consult with an attorney or other advisor regarding this Agreement, has had the opportunity to do so, and enters into this Agreement knowingly and voluntarily.

Known Claims and Disclosures

Signature

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