HR General Release Form

HR GENERAL RELEASE FORM

Parties and Identifying Information

Employee Name:

Employment and Separation Details

Job Title:    Department:

Reporting Manager:

Date Hired:    Termination Date:    Last Day Worked:

Consideration

In consideration of the promises made in this Agreement, Employer will provide to Employee the following (the "Consideration"):

Payment Date:

Release of Claims

In full and final settlement and release of all claims, Employee on behalf of Employee and Employee's heirs, agents, representatives and assigns, releases and forever discharges Employer, and its parents, subsidiaries, affiliates, predecessors, successors, officers, directors, employees and agents (collectively "Released Parties") from any and all claims, demands, causes of action, liabilities and damages of any kind, whether known or unknown, suspected or unsuspected, that arose or may have arisen up to the Effective Date of this Agreement, including but not limited to claims for: breach of contract; wrongful termination; discrimination; harassment; retaliation; unpaid wages, overtime, bonuses or commissions; emotional distress; tort; violation of any federal, state or local statute, ordinance or regulation; and any other claim arising out of Employee's employment or separation from employment.

Exceptions: Notwithstanding the foregoing, this release does not apply to (a) rights to vested benefits under any employee benefit plan that cannot be released by private agreement, (b) rights that arise after the Effective Date, (c) claims that by law cannot be released, and (d) any right to indemnification to which Employee may separately be entitled under an express indemnity agreement.

Employee expressly waives any rights Employee may have under applicable statutes to the extent permitted by law to release unknown claims, and acknowledges that the release includes unknown and unanticipated claims. Employee understands and acknowledges that this waiver and release are intended to be as broad and inclusive as permitted by law.

Confidentiality and Non-Disparagement

Confidential Information: Employee will keep confidential the terms of this Agreement and all confidential business information of Employer. Employee will not disclose the terms of this Agreement except (i) to Employee's spouse, tax or legal advisors who agree to keep such terms confidential, (ii) as required by law, or (iii) with the prior written consent of Employer.

Non-Disparagement: Employee agrees not to make any false or disparaging statements, either written or oral, about Employer, its officers, directors or employees. Employer agrees that it will direct its officers and managers not to make disparaging statements regarding Employee.

Return of Property and Cooperation

Employee agrees to return all Employer property, proprietary materials, records, keys, badges, electronic devices and documents in Employee's possession on or before the Last Day Worked. Employee agrees to cooperate reasonably with Employer regarding matters that pertain to events that occurred during Employee's employment at Employer, provided such cooperation does not unreasonably interfere with Employee's ability to obtain subsequent employment.

Tax Treatment and Withholding

Employee acknowledges that Employer makes no representation as to the tax treatment of the Consideration. Employer will withhold payroll taxes and other required withholdings from payments where required by law. Employee assumes sole responsibility for the tax consequences of the Consideration and for consulting Employee's own tax advisors.

Acknowledgements and Covenants

Employee acknowledges and agrees that Employee has been advised in writing to consult with an attorney prior to signing this Agreement, has been provided a reasonable period to consider the Agreement, and signs it knowingly and voluntarily without duress or undue influence. Employee further acknowledges that Employee has read this Agreement in its entirety, understands its terms, and enters into it voluntarily.

Employee represents that Employee has not filed any claim against Employer that Employee is not authorized to release, and that Employee will not pursue any action covered by this release.

I affirm that I have read and understand the provisions of this Agreement and that I enter into it voluntarily.

I authorize Employer to contact my previous employers and references for verification consistent with this Agreement and acknowledge that Employer may perform background checks to the extent permitted by law.

Employment History (for HR records)

Previous Employer 1

Start Date:    End Date:

Previous Employer 2

Start Date:    End Date:

Education

References (for HR records)

Legal Notices and Disclosures

At-Will Employment: Employee acknowledges that nothing in this Agreement is intended to alter the at-will nature of Employee's employment, if applicable, unless a separate written agreement expressly states otherwise.

Equal Opportunity: Employer affirms its commitment to equal opportunity in employment and that this Agreement is entered into consistent with Employer's policies and applicable law.

Miscellaneous

Entire Agreement: This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether written or oral.

Severability: If any provision of this Agreement is found to be invalid or unenforceable, the remainder shall remain in full force and effect, and the invalid provision shall be reformed to reflect the parties' intent to the maximum extent permitted by law.

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the state indicated below without regard to its conflicts of law principles.

Employee Certification

I certify that all information provided in this form is true and complete to the best of my knowledge. I acknowledge that I have read this General Release Form in its entirety, that I understand its terms, and that I enter into it voluntarily. I further acknowledge that I have been given a reasonable period in which to consider this Agreement and the opportunity to seek legal counsel.

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