Indiana Employment Separation Agreement & General Release


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                             This Employment Separation Agreement & General Release is used by a company when
                             terminating an employee. It provides for unemployment insurance benefits and a
                             severance payment to the terminated employee. In exchange, the terminated employee
                             agrees to release the company from any and all claims and actions arising out of his or her
                             employment at the company. This document should be used by companies located in
                             Indiana when terminating an employee as a means of protection from future litigation
                             arising out of the employment relationship.

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“Agreement”) is made effective as of ______ [Month] ____ [Date], 20___ [Year], by and
between __________________________ [Instruction: Insert the name of the employee]
herein after referred to as the “Employee” and ___________________________ [Instruction:
Insert the name of company] including its members, owners, directors, agents, employees,
attorneys, assigns, and representatives hereinafter referred to as the “Company”.

WHEREAS the Employee has been employed as the _______________________ [Instruction:
Insert the designation of the Employee] from ____ [Month] ___ [Date], 20____ [Year];

WHEREAS the Employee is irrevocably separating from employment with the Company
effective ______ [Month] ____ [Date], 20___ [Year], hereinafter termed as the “Employment
Termination Date”.

WHEREAS it is the desire of the Company and the Employee to set forth herein their mutual
agreement with respect to all matters relating to (i) the Employee’s separation from employment
with the Company; and (ii) the Employee’s release of claims, all set forth herein;

NOW THEREFORE, for and in consideration of the mutual covenant and promises contained
herein, the parties hereby agree to as follows:

   1. Termination of Employee.
       Separation from employment was involuntary, occurring in connection with
       [Instruction: Insert list of reasons. E.g., Reduction in workforce brought about by
       economic conditions in the company’s marketplace, etc.] The Company agrees that
       Employee is entitled to receive unemployment insurance benefits as a result of the

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       termination. Company specifically confirms that there was no misconduct on the part of
       Employee, as the term “Misconduct” is defined for purposes of determining eligibility for
       unemployment insurance benefits. [Optional]

   2. Payment and Other Compensation. On Employment Termination Date, separately
       from this agreement, the Company has paid to Employee unconditionally all wages
       earned ________ ($___) [Instruction: Insert the wages earned, e.g., Five hundred
       dollars only ($500)] through Employment Termination Date. Those payments were
       made by checks, wire transfer, cash, or direct account deposit, which are separate from
       the severance payment described later in this paragraph. Employee’s receipt of the
       accrued wages and accrued vacation were not in any way dependent on his Agreement to
       sign this Agreement in exchange for a severance payment.

   3. Severance Payment. In addition to the foregoing, and in exchange for the mutual
       promises contained in this agreement, Company agrees to pay to Employee upon his
       signature of this Agreement a single severance payment in the gross amount of ________
       ($___) [Instruction: Insert the wages earned E.g., five thousand dollars only
       ($5,000)]. Employer will deduct from that gross amount the withholding amounts
       required by state and federal law. As required by law, that amount will be included in
       Employee’s gross earnings for calendar year 20____ [Instruction: Insert the calendar
       year e.g., 2010].

   4. General Release. In exchange for the promises of Company contained in this
       Agreement, Employee hereby releases, acquits, and forever discharges the Company
       and/or its parent corporation, subsidiaries, divisions, predecessors, successors, and
       assigns, as well as past and present officers, directors, employees, shareholders, trustees,
       joint ventures, partners, and anyone claiming through them herein after termed as the
       “Released Parties” including their agents, employees, officers, and directors from all
       claims, controversies, grievances, disputes, and actions of every kind, known or
       unknown, vested or contingent, past or present, arising out of his employment at
       Company. This release includes all claims for breach of contract, claims for defamation,

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       or for violation of civil rights, claims for harassment, retaliation, and/or discrimination
       under the Civil Rights Act of 1964, the Family & Medical Leave Act, the National Labor
       Relations Act, the Labor Management Relations Act, the Pregnancy Discrimination Act
       and its state counterpart, claims arising through the date hereof under the Age
       Discrimination in Employment Act of 1967 (as amended by the Older Workers Benefit
       Protection Act), and its state counterpart, and claims under any other federal, state or
       local statute, law, or regulation. Employee releases Released Parties from all claims
       related to delivery or non delivery to him/her of any notice required by the Consolidated
       Omnibus Budget Reconciliation Act (COBRA), concerning the Employee's right to
       continued health and/or dental insurance benefits following his or her separation from
       employment with Company. The Payment and Compensation amounts set out in
       Paragraph 2, including the Severance Payment set out in Paragraph 3, are deemed by the
       parties to exceed the amount of wages, salary, regular time pay, commissions, overtime
       pay, premium pay, compensatory time, meal break penalties or wages, rest break penalty
       or wages, penalties concerning the provision or non provision of itemized wage
       statements, retaliation, and waiting time penalties, which are due to Employee and

   5. Pending and Future Legal or Administrative Actions. Employee represents that there
       are no actions, whether in court, before any agency, or otherwise, asserting claims by or
       on behalf of Employee against any of the Released Parties, including but not limited to,
       actions that concern allegations based on Employee’s employment with Company.
       Employee agrees to file no action in the future concerning his employment with Released
       Parties, or concerning this agreement.

   6. Defense to Further Action. This Agreement shall constitute a full and complete defense
       to, and may be used as a basis for an injunction against, any action, suit, or other
       proceeding which may be instituted, prosecuted, or attempted by Employee in breach of
       this Agreement. In the event that Employee institutes or is a party to any such action, that
       claim shall be dismissed with prejudice and with an award of attorneys' fees and costs to

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       any party incurred as a result of such action, immediately upon presentation of this

   7. Construction. This Agreement shall be governed by and construed in accordance with
       the laws of the State of Indiana.

   8. Entire Agreement. This Agreement constitutes the entire agreement of the parties with
       respect to the subject matter of this Agreement.

   9. Partial Invalidity. If any provision of this Agreement is held by a court of competent
       jurisdiction to be invalid, void, or unenforceable, the remaining provisions shall
       nevertheless continue in full force without being impaired or invalidated in any way.

   10. Execution. This Agreement may be signed in counterparts and on separate signature
       pages. These separate signature pages will become part of the integrated Agreement.
       Where convenient for the parties to do so, the signed signature pages may be facsimile

   11. Thorough Review. Employee hereby acknowledges that he has carefully read all of the
       terms of this Agreement. Employee acknowledges that he had the opportunity (at his own
       expense) to consult counsel in the discussion and negotiation of this settlement agreement
       and either did so or voluntarily declined that opportunity.

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The effective date of this Agreement is the date of signature by Employee.

For Company:
_________________________________                      ______ [Month] ___ [Date], 20___ [Year]
[Instruction: Insert the signature of company representative]
Name and Designation

By Employee:
_____________________________                          ______ [Month] ____ [Date], 20___ [Year]
[Instruction: Insert the signature of employee]
Name and Designation

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