HR Settlement Statement

HR SETTLEMENT STATEMENT

Settlement Date:   Effective Date of Separation:

Parties

Personal & Position Information

Reporting Manager:   Start Date:   Termination Date:

Settlement Summary (Itemized)

Severance Pay (amount):   Severance Basis (weeks/months):

Accrued Vacation / PTO Payout:   Unpaid Wages / Final Pay:

Pro-Rata Bonus / Commissions:   Expense Reimbursements:

Gross Settlement Amount:   Estimated Taxes / Withholding:

Deductions (itemize):   Net Settlement Payment:

Lump sum payment    Installments per schedule below

Release, Waiver and Exceptions

In consideration of the payments and benefits set forth above, and other good and valuable consideration, Employee hereby fully releases and forever discharges Employer, its parent and affiliated entities, and their respective officers, directors, employees and agents from any and all claims, causes of action, demands, liabilities and damages, whether known or unknown, arising out of or related to Employee's employment, separation, or any acts occurring prior to the Effective Date of Separation, except as expressly reserved below.

Confidentiality & Non-Disparagement

Employee agrees to keep the terms, amount and nature of this Settlement strictly confidential and not to disclose such information except as required by law, to immediate family, or to Employee's legal or tax advisors who agree to maintain confidentiality. Employee further agrees not to make any false or disparaging statements regarding Employer or its officers, directors, or employees.

Employee acknowledges that breach of confidentiality or non-disparagement provisions will entitle Employer to injunctive relief and damages, including reasonable attorneys' fees.

Return of Company Property & Cooperation

Employee agrees to cooperate with reasonable transition and exit activities for a period of following the Effective Date, including returning property and providing reasonable information about ongoing matters.

Taxes & Withholding

All payments called for under this Settlement are subject to required tax withholdings and deductions. Employer makes no representation as to the tax treatment of any payments; Employee is encouraged to consult a tax advisor. Employee will be responsible for any personal tax liabilities arising from payments under this Agreement, except as required by applicable law.

Benefits & Continuation

Employer will provide benefits continuation in accordance with applicable plan terms and law. Employee may elect continuation coverage where permitted; Employee is responsible for any employee portion of premiums unless specified otherwise below.

Benefits Continuation Provided:   Employer Contribution (if any):

Governing Law & Dispute Resolution

This Settlement shall be governed by and construed in accordance with the laws of the state of without regard to its conflict of laws rules. Any dispute arising under or related to this Settlement shall be resolved by the courts of that state or a federal court located therein, subject to applicable jurisdictional requirements.

Acknowledgements & Employee Certification

By signing below, Employee certifies that: (a) Employee has read and fully understands this Settlement; (b) Employee has been advised to consult with an attorney and had the opportunity to do so; (c) the terms hereof are accepted voluntarily and without coercion; and (d) all information provided in this document is true and complete to the best of Employee's knowledge.

Employee acknowledges that, except as expressly provided in this Settlement, Employee has not relied on any representation, promise or agreement by Employer or its representatives other than those contained in this Settlement.

Employment History

Dates Employed:

Dates Employed:

Education

Graduation Date:

References

Authorizations

I authorize Employer to contact prior employers for verification and customary reference checks.

I authorize Employer to conduct background checks and verify information provided in this document, subject to applicable law.

Equal Opportunity & At‑Will Statement

Employer is an equal opportunity employer and does not discriminate on the basis of protected characteristics. Nothing in this Settlement modifies any existing at-will employment relationship unless expressly set forth in writing herein.

Miscellaneous Provisions

This Settlement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, understandings and representations. If any provision is found unenforceable, the remaining provisions shall remain in full force and effect.

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