Employee Waiver Endorsement

EMPLOYEE WAIVER ENDORSEMENT

Employer Name:   Employee Name:

Effective Date:

Personal Information

Position Information

Employment History (Most Recent 2)

Dates Employed: From to

Dates Employed: From to

Education

Professional References

Waiver Endorsement — Terms and Acknowledgements

Recitals: The parties acknowledge that the Employee is executing this Employee Waiver Endorsement in connection with certain employment matters and potential claims arising prior to and including the Effective Date set forth above. In consideration of the payments, benefits, or continued employment indicated separately by the Employer, Employee hereby agrees as follows.

1. Waiver and Release of Claims. Employee knowingly and voluntarily waives, releases, and forever discharges Employer and its affiliates, officers, directors, employees, agents, successors, and assigns from any and all claims, demands, actions, causes of action, liabilities, and damages, whether known or unknown, that Employee may have arising out of or relating to Employee’s employment or separation of employment through the Effective Date, including without limitation claims for wrongful termination, discrimination, harassment, retaliation, breach of contract, and statutory claims under federal, state, or local law.

2. Scope of Release. The waiver and release set forth in this agreement covers all claims that have been or could have been asserted through the Effective Date, but does not waive Employee’s rights to vested benefits under any qualified retirement plan, or claims that cannot be waived as a matter of law. Employee affirms that no additional claims are being reserved except as expressly stated herein.

3. Consideration. Employee acknowledges receipt of sufficient consideration for the promises in this Endorsement as indicated by the Employer’s separate written offer of consideration, and Employee acknowledges that such consideration is fair, adequate, and intended to induce execution of this Endorsement.

4. Confidentiality and Non-Disclosure. Employee agrees to maintain the confidentiality of the terms and amounts of any settlement or consideration provided in connection with this Endorsement, except as required by law or to secure legal or tax advice. Employee further agrees not to disclose confidential business information or trade secrets of Employer pursuant to the separate confidentiality obligations of Employee.

5. No Admission of Liability. The parties agree that execution of this Endorsement does not constitute an admission by Employer of any wrongdoing or liability.

6. Cooperation. Employee agrees to cooperate with Employer in any reasonable investigation or proceeding related to matters covered by this Endorsement, provided that any cooperation request is reasonable in scope and duration.

7. Acknowledgement of Rights and Advice of Counsel. Employee acknowledges that Employee has been advised to consult with legal counsel prior to signing this Endorsement, and that Employee has had sufficient time to consider its terms. Employee affirms that Employee understands the rights being waived and accepts this Endorsement voluntarily and without coercion.

8. No Revocation. Employee understands and agrees that, except where a statutory right to rescind is provided by law, this Endorsement is final and not subject to unilateral revocation by Employee following execution.

9. Tax Consequences. Employee acknowledges that any payments or benefits provided under separate cover may have tax consequences. Employee accepts responsibility for any tax obligations and acknowledges that Employer has not provided tax advice.

10. Severability. If any provision of this Endorsement is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

11. Governing Law. This Endorsement shall be governed by and construed in accordance with the laws of the state governing the employment relationship, without regard to conflict of law principles.

Legal Disclosures & Authorizations

I acknowledge receipt of the Employer's At-Will Employment statement and understand that, unless otherwise set forth in a signed written agreement, employment remains at-will and may be terminated by either party at any time.

I acknowledge the Employer's Equal Employment Opportunity statement and understand the Employer's commitment to non-discrimination.

I authorize the Employer to contact prior employers and references and to obtain background checks to the extent permitted by law, and I release such parties from liability for providing such information.

Applicant Certification: I certify that all information provided in this document is true and complete to the best of my knowledge. I acknowledge that falsification or omission may be grounds for denial of consideration or disciplinary action up to and including termination.

Additional Comments (Optional)

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