Employment Termination Confirmation

EMPLOYMENT TERMINATION CONFIRMATION

Employee Information

Employee Name:

Position and Employment Details

Reporting Manager:

Hire Date:    Termination Effective Date:

Last Day Worked (if different):

Termination Details

Termination Reason (select all that apply):

Voluntary Resignation    Involuntary — For Cause    Layoff / Reduction in Force

Retirement    End of Contract    Other:

Final Pay, Benefits & Property

Severance Offered: Yes No   If yes, amount:

Employee offered continuation of group health benefits under company policy: Yes No

Please indicate items returned and date returned:

Laptop/Tablet — Date Returned:

Company Phone — Date Returned:

Keys/Access Cards — Date Returned:

Other — Describe and date returned:

Post-Employment Obligations & Acknowledgements

The employee remains bound by any confidentiality, non-solicitation, non-compete and proprietary information obligations contained in prior agreements with the Employer. Employee acknowledges obligation to comply with those post-employment restrictions as applicable.

Employee acknowledges receipt of this Termination Confirmation and understands the items above regarding final pay, benefits continuation, and property return.

I acknowledge the foregoing and understand my obligations.

Rehire Eligibility & Appeal

Rehire Eligibility: Eligible    Not Eligible

Employment Record Summary

Provide two most recent prior employer records as they appear in personnel file.

Education

References

Provide three professional references.

Legal Notices

At-Will Employment: Nothing in this confirmation alters the employment-at-will relationship unless expressly set forth in a separate written agreement signed by an authorized representative of the Employer. Both Employer and Employee retain all rights and obligations under any executed written agreement addressing modification or termination of employment.

Equal Opportunity Statement: Employer is an equal opportunity employer. Termination decisions were made consistent with applicable federal, state and local law prohibiting unlawful discrimination.

Employee Certification and Authorization

I certify that all information contained in this Termination Confirmation is accurate to the best of my knowledge. I authorize the Employer to verify employment records and to provide truthful information about my employment to prospective employers or government agencies as permitted by law.

I certify that the information above is true and complete.

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