Employee Severance Release

EMPLOYEE SEVERANCE RELEASE

Parties and Basic Information

Employee Name:

Employer Name:

Position and Separation Details

Reporting Manager:

Date of Hire:    Date of Termination:

Severance Terms and Consideration

In exchange for the promises and releases contained in this Employee Severance Release (the Release), Employer agrees to provide the following consideration to Employee, subject to the conditions below.

Payment Schedule:

Final Pay for Earned Wages and Accrued PTO:

Benefits and Continuation

Employer will continue employee health benefits through: . Thereafter, Employee may be eligible for continuation coverage at Employee's expense where permitted by law.

Employee Responsibility for Premiums:

Release of Claims

In consideration of the Severance Payment and other obligations set forth herein, Employee, on behalf of Employee and Employee's heirs, executors, administrators and assigns, forever releases and discharges Employer and its past and present parents, subsidiaries, affiliates, officers, directors, employees, representatives and agents (collectively Released Parties) from any and all claims, demands, causes of action, liabilities, and damages of any nature whatsoever, whether known or unknown, asserted or unasserted, arising prior to the Effective Date of this Release, including but not limited to claims arising from or related to Employee's employment or termination of employment.

Known claims or administrative charges pending:

Confidentiality, Non-Disparagement and Return of Property

Employee agrees to keep the terms, amount and conditions of this Release confidential and not to make any disparaging statements concerning the Released Parties. Notwithstanding the above, Employee may disclose information as required by law or to obtain legal or tax advice.

Tax Treatment and Withholding

All amounts payable under this Release are subject to required tax withholding and reporting. Employer makes no representations regarding the tax consequences of any payments made under this Release. Employee is advised to consult a tax advisor about the tax consequences.

Mutual Release and No Admission

Employer and Employee each agree that this Release is not, and shall not be construed as, an admission of liability or wrongdoing by either party. To the extent Employer provides any release in favor of Employee, such release shall be expressly mutual.

Review Period and Revocation

Employee acknowledges receipt of this Release and understands Employee has a period of days from the date below to consider this Release. If applicable, Employee may have a revocation period that runs through: .

Employee Representations and Cooperation

Employee represents that Employee has not filed or initiated any lawsuits or claims against the Released Parties other than those disclosed above, and that Employee has the full right and authority to enter into this Release. Employee agrees to cooperate reasonably with Employer in matters related to Employer's business where such cooperation does not unreasonably interfere with Employee's employment or post-employment obligations.

Employment History (for Verification)

Prior Employer 1

From:    To:

Prior Employer 2

From:    To:

Education

Graduation Date:

References

Reference 1

Reference 2

Reference 3

Legal Notices and Statements

At-Will Employment Statement: Nothing in this Release alters the at-will nature of Employee's employment, unless expressly stated in a separate written agreement signed by an authorized representative of Employer.

Equal Opportunity Statement: Employer maintains a policy of equal employment opportunity and makes employment decisions without regard to protected characteristics. Nothing in this Release is intended to alter Employer's nondiscrimination obligations under applicable law.

Employee authorizes Employer and its agents to contact any current or former employers, educational institutions, references, and other third parties to verify information and conduct background checks as necessary to effect the terms of this Release.

  I authorize verification and background checks as described above.

Employee Certification

I certify that all information provided in connection with this Release is true and complete to the best of my knowledge. I acknowledge that I have read this Release, understand its terms, and have had the opportunity to seek independent counsel.

Employee Signature Date:

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