Pennsylvania Notice of Dismissal of Employee

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									Notice of Dismissal



                          This form is a Notice of Dismissal of Employee which spells out the reasons
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                          for termination of the Employee. Date of final paycheck is noted. Employee
                          is told to report discuss insurance and accrued benefits, if any, with the
                          appropriate authorities. All other benefits to which the Employee is entitled
                          to may be paid in accordance with company policy.




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                                                                                              Attorney Drafted
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                                    NOTICE OF DISMISSAL

_____ [Month] _____ [Date], 20_____

________________________ [Instruction: Insert the employee name]

________________________ [Instruction: Insert the company]

________________________ [Instruction: Insert the employee address]

Dear [Employee]:

We regret to notify you that your employment with the firm shall be terminated on _____
[Month] _____ [Date], 20____, because of the following reasons:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
[Instruction: Please detail the reasons for the termination of the employee in above
provided space]

You will receive your regular pay up to and including today, _____________ [Date].

(IF APPLICABLE) You will receive an additional _____________ [Comment: this will
depend upon the Record] [◊two (2)] weeks of pay in lieu of notice of termination as per our
obligations under the Pennsylvania Code.

(IF APPLICABLE) Your entitlement to our group health benefits program will continue during
your notice period, with the exception of [depends on the plan], which ceases effective
immediately.

You will receive a further payment which will represent your accrued and owing vacation pay.

These payments together with your record of employment will be delivered to you within
___________ (___) [◊ten (10)] days of today’s date.

(IF APPLICABLE) We wish to amicably and completely bring closure to your employment
and to assist you in this transition. We are therefore prepared to offer you an additional
___________ (___) [◊two (2)] weeks of termination pay, to be paid to you in a lump sum, less
applicable statutory withholdings. Please note that this offer is conditional upon you keeping its
terms strictly confidential, with the exception of your legal counsel. This offer will remain in
force for your consideration until _____ [Month] _____ [Date], 20_____

If the terms of this separation offer are acceptable to you, please sign below and attach a signed
and witnessed copy of the attached Release Form as Exhibit A. When you have signed, the




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terms of this letter will become a binding agreement upon you and ________________________
[Instruction: Insert the company].

We deeply regret the need for this action.



Sincerely,


___________________________________

[HR Representative]


cc:   [List carbon copy name(s)]




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                                            EXHIBIT A

                                        RELEASE FORM




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