HR Separation Release Form

HR SEPARATION RELEASE FORM

Personal Information

Position and Separation Details

Manager / Supervisor:

Hire Date:    Separation Date (last day worked):

Separation Compensation and Benefits

Employer agrees to provide the following consideration in exchange for the Release set forth in this form: Total severance payment of payable as follows: .

Accrued but unpaid vacation / PTO payout: . Final base wages to be paid on: .

Benefits continuation offered: (select if applicable). If continuation is elected, the cost allocation, effective date and duration will be provided separately by Employer.

Return of Property and Company Materials

Employee agrees to return all Company property, including but not limited to keys, access badges, laptops, mobile devices, documents, and proprietary materials by or on the last day of employment. Items not returned will be reimbursed to Employer and may be deducted from final compensation to the extent permitted by law.

Release of Claims and Consideration

In consideration of the payments and benefits described above, and other good and valuable consideration, Employee hereby fully releases and forever discharges Employer and its past and present affiliates, parents, subsidiaries, officers, directors, agents, employees and assigns from any and all claims, demands, causes of action, liabilities, and damages of any kind, whether known or unknown, arising out of or related to Employee's employment or separation through the Effective Date below. The total consideration for this Release is identified as .

Effective Date of Release: . Employee acknowledges receipt of the consideration described and that the obligations described herein are a bargained-for exchange.

Confidentiality, Non-Disparagement, and Cooperation

Employee agrees to keep the terms of this Separation and Release confidential except as required by law or to immediate family or professional advisors who agree to keep the terms confidential. Employee agrees not to make disparaging remarks about Employer, its officers, directors or employees. Employee further agrees to cooperate, upon reasonable request and at Employer's expense when appropriate, with Employer in any matters related to operations, litigation or regulatory inquiries that reasonably relate to Employee's period of employment.

Non-Admission and Tax Acknowledgment

This Agreement does not constitute an admission of liability by either party. Employee is responsible for any applicable taxes on payments received and agrees that Employer's processing of payments shall conform to applicable tax withholding and reporting requirements.

Acknowledgements and Certifications

Employee acknowledges that Employee has read this Separation Release Form, understands its terms, and knowingly and voluntarily enters into it. Employee certifies that all information provided in this form is true and complete to the best of Employee's knowledge.

Employee hereby authorizes Employer to contact previous employers, references and educational institutions for verification of employment, education and other information provided by Employee. Employee releases all such parties from liability for providing such information to Employer.

I authorize Employer and its agents to conduct employment verification, reference checks, criminal background checks and other investigations as permitted by law. I understand that such checks may be used to determine eligibility for certain post-employment benefits and other administrative matters.

Authorization: I authorize the investigations described above.

Employment History (For Employer Records)

Dates Employed:

Dates Employed:

Education

Graduation Date:

References

Legal Notices

At-Will Employment: Employee acknowledges that, unless otherwise provided in a separate written agreement signed by authorized representatives of Employer, Employee's employment is at-will and either party may terminate the employment relationship at any time, with or without cause.

Equal Opportunity: Employer is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by applicable law.

Representations, Severability, and Governing Law

Employee represents that Employee has read and fully understands all provisions contained herein and that Employee executes this Separation Release Form voluntarily. If any provision is found to be unenforceable, the remaining provisions shall remain in full force and effect. This Agreement shall be governed by the applicable law specified in Employer's policies and by the laws of the jurisdiction where Employer maintains its principal place of business to the extent not preempted by controlling law.

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