HR Settlement Release Form

HR Settlement Release Form

Parties and Identification

This Settlement and Release Agreement (the Agreement) is made between Employer Name: and Employee Name: .

Personal Information

Position Information

Employment start date:   Last day of work / separation date:

Employment History (Most Recent)

Dates of employment:

Employment History (Prior)

Dates of employment:

Education

Graduation date:

References

Legal Disclosures

At-Will Employment Statement: Employee acknowledges and agrees that, unless otherwise agreed in a separate written agreement signed by an authorized representative of Employer, employment remains at-will and may be terminated by either party at any time, with or without cause.

Equal Employment Opportunity: Employer reaffirms that it is an equal opportunity employer and neither party asserts that this Agreement modifies the Employer's commitment to nondiscrimination in employment practices.

Settlement Terms and Consideration

Consideration: In consideration of the promises and releases contained herein, Employer agrees to pay Employee a total gross settlement amount of $ (the Payment).

Employee acknowledges that the Payment is full and complete consideration for the releases in this Agreement, subject to applicable tax withholding as described below.

Release and Waiver of Claims

Release: Employee, on behalf of Employee and Employee’s heirs, agents, representatives, successors and assigns, hereby releases and forever discharges Employer and its affiliates, officers, directors, employees and agents from any and all claims, demands, liabilities, actions, causes of action, damages, losses and expenses, whether known or unknown, suspected or unsuspected, arising out of or relating to Employee's employment with Employer or the termination thereof through the Effective Date of this Agreement, except as expressly preserved in this Agreement.

Carve-outs: Notwithstanding the foregoing, this release does not apply to (a) obligations arising under this Agreement; (b) rights to any vested benefits under any plan that cannot be legally released; (c) claims for unemployment insurance or workers' compensation benefits to the extent not waivable; or (d) any rights which cannot be waived as a matter of law.

Confidentiality; Non-Disparagement

Confidentiality: Employee agrees to keep the terms, amount and existence of this Agreement strictly confidential and not to disclose them to any third party except as required by law, to Employee's immediate family, or as necessary to enforce this Agreement, in which case Employee must first provide Employer notice.

Non-Disparagement: Employee agrees not to make any statements, written or oral, that are false or would reasonably be expected to disparage Employer, its officers, directors or employees. Employer agrees that it will provide neutral employment verification regarding Employee's dates of employment and title unless otherwise required by law.

Taxes

Taxes: Employer will withhold from the Payment any taxes required by law. Employee acknowledges that Employer makes no representations regarding the tax treatment of the Payment and that Employee is solely responsible for all tax reporting and payments related to the Payment.

Return of Property and Cooperation

Employee certifies that Employee has returned all Employer property, including but not limited to keys, access cards, electronic devices, documents and confidential information, and will cooperate with Employer in transition matters for a reasonable period upon request.

Representations; Entire Agreement; Governing Law

Employee represents that Employee has not assigned or transferred any of the claims released herein. This Agreement constitutes the entire understanding between the parties concerning the subject matter and supersedes all prior agreements. If any provision is held invalid, the remaining provisions shall remain in full force. This Agreement shall be governed by the laws of the state selected by Employer in its standard agreements.

Acknowledgements and Certifications

I certify that all information provided in this form is true and complete to the best of my knowledge and that I have not omitted any material fact. I have read this Agreement, understand its terms, and enter into it knowingly and voluntarily. I acknowledge that I have been given the opportunity to consult with counsel of my choice prior to signing.

Authorization: I authorize Employer to contact my prior employers and references and to conduct background checks to the extent permitted by law as necessary to verify the representations I have made.

Employee Certification (Signature Required)

Employee confirms receipt of a copy of this Agreement and acknowledges that the effective date of this Agreement is the date of the last signature below or any specified effective date provided herein.

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