Employment Separation Agreement

Information you will need

• What’s the date of this agreement?
• What's the employer's mailing address?
• What's the employee's mailing address?
• What's the last date of employment?
• On what date will the severance payments end?
• What's the severance amount? (if applicable)
• What industries does the non compete cover? (if applicable)
• What's the non compete area?
• Where's the radius measured from?
• What radius does the not compete cover? (if applicable)
• What state laws govern this agreement?
• What are the additional terms or conditions?
• What's the employer's name?
• Who's signing this agreement for the employer?
• What's the person's title?
• What's the employee's name?
• What's the employee's printed name?
• Is there a non compete condition?
• Until what date will the employee receive benefits?
• Up to what date has the employee been paid?
• What's the severance type?
• How often will severance payments be made?
• On what other basis will severance payments be made?
• Is additional severance being provided?

…and 10 more fields in the PDF.

Completed by the employee and the employer and the agent.

The form includes 2 signature lines.