Employment Separation Agreement

An employee separation (severance) agreement allows an employer and employee to come to a mutual agreement for the termination of employment.

Who is the EMPLOYEE being terminated?

Enter the employee's name.

Do you know the Employee's Mailing Address?

Do you know the Employee's Mailing Address? YesNo

Employee's Mailing Address

Street Address

Address Line 2

City

State

ZIP Code

The Employer

Employer's Name

Employer's Address (main office)

Street Address

Address Line 2

City

State

ZIP Code

Supervisor

Supervisor's Name

The individual signing this agreement.

Role in the Company

Role in the Company PresidentCEOOfficerMemberVice PresidentOther

Role in the Company

Employee's Status

Is the Employee owed payment for past work?

Is the Employee owed payment for past work? YesNo

When was the Employee LAST PAID?

Last Day

When is/was the LAST DAY of the employee?

Severance

Will the Employee receive payment as part of this Agreement?

Will the Employee receive payment as part of this Agreement? Yes, payment is involvedNo, payment is not involved

Such as a 1-time payment or a severance package which involves continuing their pay for a specified time-period (commonly 1 or 2 weeks).

The Employer agrees to pay Severance as a

The Employer agrees to pay Severance as a Single PaymentMultiple Payments (continuation of pay or salary)

Severance is paying a former employee after they no longer work for the Employer.

Payment Amount

Enter the Payment Amount

Payments shall be made on a

Payments shall be made on a WeeklyBi-WeeklyMonthlyOther

Payments shall be made on a

Basis

Payments shall end on

Other Severance

Will there be ANY OTHER severance?

Will there be ANY OTHER severance? YesNo

Examples: Company Property (equipment, computers, etc.), Ownership in the Company, an Additional Cash Payment, etc.

The Employee shall be due the following:

Returning Property

Will the Employee be required to return any Company Property?

Will the Employee be required to return any Company Property? YesNo

Such as tools, laptops, phones, etc.

Is there any Company Property you would like to specify?

Is there any Company Property you would like to specify? YesNo

Specify the Company Property:

List all Company Property that is required to be returned by the Employee.

Company Property must be returned by

Employee's Benefits

Will the Employee's Benefits terminate on their Last Day?

Will the Employee's Benefits terminate on their Last Day? YesNo

Employee's Benefits will be valid until

Non-Compete

Is the Employee able to work in the same industry IMMEDIATELY AFTER termination?

Is the Employee able to work in the same industry IMMEDIATELY AFTER termination? YesNo

If No, a Non-Compete clause would be added

Employee will be prohibited from working in the following industries:

Non-Compete Term

Term of Non-Compete

Select Interval

Select Interval Day(s)Month(s)Year(s)

Non-Compete Jurisdiction

The Non-Compete covers

The Non-Compete covers _____ Miles from a Location (radius)a U.S. StateNationwide (United States)Worldwide (International)

Which State does the Non-Compete cover?

Non-Compete shall cover

Miles

Is the Location the SAME as the Employer's Address?

Is the Location the SAME as the Employer's Address? Yes, Same AddressNo, Different Address

Non-Compete Address

Street Address

Address Line 2

City

State

ZIP Code

This Address will be the center-point of where the Employee may not enter into the same or similar business of the Employer.

Additional Terms

Are there any Additional Terms or Conditions?

Are there any Additional Terms or Conditions? YesNo

If there is any additional language the parties would like to include in the Agreement.

Write:

Governing State

Will this Agreement be governed by California law?

Will this Agreement be governed by California law? YesNo

Effective Date

Effective Date of this Agreement

Usually today's date.

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