This is an agreement between a company and a former employee that sets forth the
separation terms of the former employee. The former employee will receive a
severance package and continue to receive benefits. In exchange, the former
employee must agree to release the company against all potential claims in the future.
This document contains numerous standard provisions that are commonly included in
these types of agreements, and may be customized to fit the specific needs of the
contracting parties. This agreement can be used by small businesses or other entities
that want to provide former employees with a severance package in a return for a
release of all claims.
SEPARATION AND RELEASE AGREEMENT
This Separation and Release Agreement (hereinafter the “Agreement”) is made on this ____ day
of ___________ of ________ by and between __________________ [Comment: insert
Company name and address] (hereinafter “Company”) and ___________________________
[Comment: insert Employee name and address] (hereinafter “Employee”).
Employee was associated with Company in the position of _____________ [Comment: insert
job title]. Employee and Company have mutually agreed to amicably terminate the Employee-
As of _____________ [Comment: insert date], Employee’s relationship with Company has
II. SEVERANCE ALLOWANCE AND BENEFITS
In consideration of Employee’s agreement to the terms and releases contained in the instant
Agreement, Company will pay Employee a severance allowance in the total amount of
_____________ dollars ($_____________). Payment will be made on a payment schedule that
is consistent with Employee’s current payment schedule at a rate of _____________ dollars
($__________) per month for _______ (__) months.
Company shall continue to pay Employee’s medical coverage benefits, pursuant to the
Consolidated Omnibus Budget Reconciliation Act of 1985 (hereinafter “COBRA”), under
________________ [Comment: insert health insurance plan name].
If requested by Employee, Company will pay for a job referral and outplacement service to assist
Employee in locating future employment. Company will pay for this service for a period of
_______ (__) months after Employee’s termination or until such time as Employee secures new
Employee agrees to irrevocably and unconditionally release, acquit and forever discharge
Company and/or its assigns, successors, parent corporation, subsidiaries, divisions, and
predecessors, including its past, present and future officers, employees, directors, shareholders,
partners, and joint venturers, and any claims made through same (hereinafter “Releasees”), in
Releasees’ corporate and/or individual capacities from any and all promises, actions, claims,
liabilities and damages, both known and unknown, which Employee has or had against same
relating to or arising from Employee’s position with Company or the termination of Employee
from his/her position.
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Employee hereby warrants that he/she not bring any legal action against any of the
aforementioned Releasees for any claims released under this Agreement and further represents
that no similar or related claims have been filed as of the effective date of this Agreement.
Employee further agrees to cooperate completely and fully with Company in the event that
Company faces any administrative, judicial, or similar proceedings.
Employee agrees to not make any comments or statements that would prove to be derogatory to
Company or Company’s business or financial arrangements.
If Employee breaches any of the aforementioned terms and releases, Employee must return all
accrued severance pay to Company. All future payments will terminate immediately.
This Agreement shall be binding on the parties, their heirs, administrators, representatives,
executors, successors and assigns and shall inure to their benefit and to that of their heirs,
administrators, representatives, executors, successors, and assigns.
This Agreement constitutes the entire agreement between the parties as to the subject matter
herein, supersedes any and all prior agreements and understandings, and sets forth both parties
entire understanding of all relevant subject matter.
This Agreement shall not be amended, altered, modified, or waived without the express written
consent of both parties.
Any delay by Company in enforcing any of its rights under this Agreement will not be deemed a
waiver of those rights.
Employee hereby agrees to return to Company any confidential materials, property, or company
documents within Employee’s possession, recognizing that failing to do so may subject
Employee to prosecution under relevant statutes.
Employee agrees to keep the terms of this Agreement confidential and to only discuss
Agreement specifics with his or her respective legal and financial counsel, recognizing that
failing to do so will require relinquishment of all monies paid to Employee under this
VI. COMPANY LIABILITY
This Agreement shall not be construed as an admission of liability of any kind by Company. All
associated liability is hereby specifically denied by Company.
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VII. EMPLOYEE RIGHTS
By signing this Agreement, Employee acknowledges that Employee has the right to review and
discuss all aspects of this Agreement, and the consequences of thereof, with an attorney of
Employee’s choosing and that Employee has carefully read and understands all the conditions
and provisions of this Agreement. Employee further warrants that Employee is knowingly and
voluntarily entering into this Agreement.
If Employee does not sign this Agreement, Company will pay Employee all compensation that
Employee earned through the date of Employee’s termination, including vacation benefits and
any and all profit sharing. [Comment: other benefits as applicable]
If Employee does not sign this Agreement, Employee is still entitled to all benefits to which
Employee is entitled pursuant to COBRA.
If Employee does not sign this Agreement, Employee shall still retain all benefits under
Company’s 401(k) Plan.
Further, pursuant to the Older Workers Benefit Protection Act of 1990, Employee acknowledges
that Employee has the right to consult with an attorney before signing this Agreement and
Employee does not waive rights or claims under the Age Discrimination in Employment Act of
1967 that may arise after the date this Agreement is executed.
Employee will have ______ (___) days after signing this Agreement to revoke the Agreement.
This Agreement will only become effective after the expiration of the revocation period.
VIII. ATTORNEYS’ FEES
If judgment is required to enforce the contents of this Agreement or remedy a breach thereof,
Employee will pay attorneys’ fees of Company if his/her actions led to Company’s need for legal
IX. ASSIGNMENT PROHIBITED
Both Company and Employee are expressly prohibited from assigning this Agreement or any
rights or interest flowing herefrom. Assignment shall only occur with the express written
consent of both parties.
X. ENTIRE AGREEMENT
This Agreement sets forth the entire agreement between Employee and Company and supersedes
any and all prior oral or written agreements or understandings between Employee and Company
concerning the subject matter herein. This Agreement may not be altered, amended or modified,
except by a further written document signed by both Employee and Company.
XI. GOVERNING LAW AND CONSENT TO JURISDICTION
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This Agreement shall be interpreted and enforced pursuant to the laws of the State of
__________, without regard to conflicts of law principles. The parties agree to voluntarily
consent to the jurisdiction of all federal and state courts in the State of ________.
IN WITNESS THEREOF, the parties hereto execute this Agreement on this ____ day of
________ of ______:
Authorized Signature Authorized Signature
Name and Title Name and Title
Name and Title
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