Separation Agreement Template
1. Termination of Employment
Employment ends on [Termination Date] (the “Separation Date”).
Effective Date of this Agreement: [Date of last signature].
2. Benefits
Benefits terminate on [Date], unless continued through [Plan continuation/Other arrangement].
Benefits Contact: [Name/Email/Phone].
3. Final Compensation
Earned wages through Separation Date: [Amount/Calculation].
Unused PTO (if applicable): [Amount/Calculation].
Other compensation (if any): [Describe].
4. Severance Pay
Severance: [No severance/Severance of $[Amount] as [Lump sum/Installments]].
Payment Timing: [Date(s)/Method].
Conditions (if any): [Return of property/Transition completion/Other].
5. Return of Company Property
Return deadline: [Date]. Return method: [Drop-off/Ship/Other].
Items: [Devices/Badges/Documents/Other].
Access and credentials: [Deactivate/Transfer list].
6. Confidentiality
Confidentiality: [Continue under prior agreement/Set forth here: __].
Confidential materials handling: [Return/Deliver/Delete per policy].
7. Benefits Continuation Checklist
Benefit | End Date | Continuation Option | Contact/Method | Ref ID |
[Health] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
[Retirement] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
[Other] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
Benefit | End Date | Continuation Option | Contact/Method | Ref ID |
[Health] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
[Retirement] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
[Other] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
Benefit
End Date
Continuation Option
Contact/Method
Ref ID
[Health]
[MM/DD/YYYY]
[Option]
[Contact/Portal]
[__]
[Retirement]
[Other]
8. Non-Disparagement
Non-disparagement: No false or damaging statements.
Inquiry Contact (if any): [Name/Department/Email].
9. Release of Claims
In exchange for the consideration stated in [Severance/Other consideration], Employee releases Employer from Claims related to employment/termination, except [Excluded items].
10. Notices
Employer Notice Address: [Address/Email].
Employee Notice Address: [Address/Email].
11. Governing Law
Governing law: New York.
12. Entire Agreement
This Agreement supersedes prior discussions regarding separation.
Amendments must be in writing and signed by both Parties.
13. Neutral Reference Routing
Verification Contact: [Name/Department/Email/Phone].
Verification Items: [Dates/Title/Other].
14. Dispute Routing
Employer Contact: [Name/Title/Email/Phone].
Employee Contact: [Email/Phone].
15. Signatures
Employer Signatory: ________________________ Date: ____________ Name/Title: [Name, Title]
Payroll Acknowledgment: ____________________ Date: ____________ Name/Title: [Name, Title]
Employee: _________________________________ Date: ____________ Name: [Full Name]
Benefit | End Date | Continuation Option | Contact/Method | Ref ID |
[Health] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
[Retirement] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
[Other] | [MM/DD/YYYY] | [Option] | [Contact/Portal] | [__] |
