Employment Release Rider

EMPLOYMENT RELEASE RIDER

This Employment Release Rider (Rider) is entered into by and between Employer Name: with principal address and Employee Name: .

Termination Date: — this Rider becomes effective on Effective Date: .

Personal Information

Position Information

Start Date:    Salary at Separation: $

Employment History

Dates Employed From: To:

Dates Employed From: To:

Education

Graduation Date:

References

Legal Disclosures & Acknowledgements

At-Will Employment: Employee acknowledges that, unless an express written agreement states otherwise, employment with Employer is at-will and may be terminated by either party at any time with or without cause or advance notice.

I acknowledge and accept the At-Will Employment statement.

Equal Opportunity: Employer is an equal opportunity employer and does not discriminate on the basis of legally protected characteristics as defined by applicable law.

I acknowledge receipt of the Equal Opportunity statement.

Release of Claims

In exchange for the consideration described below, Employee, on behalf of Employee and Employee's heirs, executors, administrators and assigns, hereby releases and forever discharges Employer and its past and present parents, subsidiaries, affiliates, predecessors, successors, insurers, agents, officers, directors, employees and representatives (collectively, Released Parties) from any and all claims, demands, actions, causes of action, obligations, liabilities and damages of any nature, whether known or unknown, asserted or unasserted, fixed or contingent, that Employee has or may have against the Released Parties arising on or before the Effective Date of this Rider, including but not limited to claims arising under contract, tort, common law, statute, regulation or ordinance.

The foregoing release does not include claims that cannot be waived as a matter of law (for example, rights to unemployment compensation, workers' compensation benefits, or rights that by statute cannot be relinquished). Employee acknowledges that Employee has read and understands the scope of this release and that it is intended to be interpreted broadly.

Consideration

As consideration for the relinquishment of claims, Employer will provide Employee the following:

Employee acknowledges that the consideration described is in addition to any wages owed through the termination date and that applicable taxes and withholdings will be deducted as required by law.

Confidentiality & Non-Disparagement

Employee agrees to keep the terms, amount and existence of this Rider confidential and will not disclose such information except to Employee's spouse, attorney, tax advisor, or as required by law. Employee further agrees not to make any false or disparaging statements about Employer, its officers, directors, employees or agents.

Employee agrees to confidentiality.

Employee agrees to non-disparagement.

Return of Property and Cooperation

Employee agrees to return all Employer property, including but not limited to keys, equipment, electronic devices, documents and proprietary information, on or before the Effective Date. Employee agrees to cooperate reasonably with Employer in transition matters and in responding to inquiries concerning matters within Employee's former responsibilities.

Tax Withholding

All payments and benefits provided under this Rider shall be subject to applicable federal, state and local tax withholding and deductions as required by law. Employee is responsible for any tax liabilities arising from consideration paid under this Rider.

Governing Law; Severability; Entire Agreement

This Rider shall be governed by and construed in accordance with the laws of the State of , without regard to conflicts of law principles. If any provision of this Rider is found to be invalid or unenforceable, the remainder shall remain in full force and effect. This Rider, together with any agreement with Employer referenced herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior agreements.

Revocation; Acknowledgement

Employee acknowledges receipt of this Rider, acknowledges that Employee has been given a reasonable period to consider this Rider prior to signing, and acknowledges that Employee had the opportunity to consult with counsel. To the extent a statutory revocation period applies under applicable law, Employee understands that Employee may revoke this Rider within the period permitted by law. If no such revocation is exercised, this Rider will become final and binding.

Employee Certifications & Authorizations

I certify that all information provided in this Rider and accompanying forms is true and complete to the best of my knowledge. I authorize Employer to contact prior employers and references as reasonably necessary to verify employment history and background. I authorize Employer to conduct lawful background and reference checks to the extent permitted by applicable law.

I certify that the information provided is true and complete.

I authorize Employer to contact prior employers, references, and to conduct background checks as described.

Additional Terms

Any disputes regarding the interpretation or enforcement of this Rider shall first be attempted to be resolved through good faith negotiation. If unresolved, disputes shall be resolved by the dispute resolution mechanism agreed in the employee's primary employment agreement or, if none, in a court of competent jurisdiction in the chosen governing state.

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