Company Layoff Notice with Severance Form

Current Date

To: First Last, Contract Job Title

Re: Notice of Indefinite Layoff

This notice is to inform you that due to a insert reason here - such as "seasonal slowdown," "lack of work," "lack of funding," reorganization, etc., you will be laid off effective Start Date. As an employee with Years years of service, you are eligible to receive Weeks week(s) severance pay. If you return to work at the Company within Days days, you will be required to repay the amount of severance that exceeds the number of days you were on layoff status.

You may not return to work without first repaying the severance monies received or signing an agreement with Company to repay all severance monies owed. To elect severance pay, indicate so by signing the severance notice below and returning this Notice to the Human Resources Department within ten (10) calendar days from the date of this letter. Enclosed you will find details about the support services available to you, as well as other information that you may find useful regarding the impacts of layoff.

If you did not receive this packet of information, or if you have additional questions, please contact Human Resources Name in the Company Human Resources Department at Human Resources Phone. The Human Resources Department is also available to discuss any additional benefits, such as unemployment, training, and other benefits you may be entitled to because of this layoff. You may be eligible to continue Company-sponsored health, vision, or dental coverage via the COBRA insurance continuation program. For more information regarding COBRA and how to continue these benefits, please contact Human Resources Name in the Company Human Resources Department at Human Resources Phone.

The Human Resources Department is also able to answer any other questions you may have concerning all Company policies, benefits and other employment issues.

Human Resources Manager

cc: Human Resources Manager

Department Manager

Personnel File

Notice of Election of Severance

For valuable consideration received, Employee and Employer hereby agree to the following conditions for receiving severance pay upon separation from Employer. Employer agrees to pay employee ($ insert dollar amount of payment or number of weeks of salary weeks of salary at the employee's rate of pay prior to the date of this letter). Employee will not disclose or distribute in any format or forum any information about the Employer or its clients, vendors, employees, partners, officers, directors or its affiliated companies that Employee knows to be confidential or considered to be trade secret, trademark, service mark, trade name, patent, or copyright, including information or a product invented or developed by Employee or Employer during the course of their employment with Employer. Employee agrees not to make statements relating to their employment or this agreement that can be construed as libelous, slanderous, critical or otherwise derogatory of Employer its employees, agents, partners, shareholders, officers, directors, and affiliated companies.

Employee certifies that they have turned in to Employer all letters, documents, memoranda, papers, notes and all electronic copies thereof or any other materials or Intellectual Property that are the rightful property of Employer. Employee also certifies that they are not in current possession of all other tangible Employer property, including, but not limited to: keys or physical access devices, products, equipment, media, any Employer source code, object code, telephones, charge cards, vehicles or any other tangible property. If Employee has access to Employer computers, servers, accounts, subscriptions or other Employer property shall not access those resources for any reason without explicit permission from the Employer. Employer will pay Employee any outstanding hours owed from an approved timesheet, including any funds owed from their health savings account or medical contributions made by Employee to Company Health plan in the form of a check mailed to Employees residence.

Employee is responsible to give Employer an updated address in order to receive their tax documents (W-4, 1099, etc) for the next tax year. Employer and Employee further agree that in the event of any breach or threatened breach of this Resignation Agreement or default hereunder; the injured party has the right to pursue any legal action available to enjoin the breaching party from further injurious conduct and or to recover damages from the breaching party for their conduct.

Employee Statement:

I hereby wish to elect the Company's offer of severance pay as described below. By electing severance pay, I understand that I will forfeit all rights to preferential rehire and recall. I understand and agree that by electing severance pay, my layoff will create a break in service. I further understand and agree that prior to any re-employment with the Company, I will be required to repay the amount of severance that in is excess of the regular salary earned while on layoff status, and be subject to possible lien or garnishment of wages through automatic payroll deduction until such amount has been paid in full to the Company.

I understand and agree that my election of severance pay is irrevocable and agree to be bound by all of the terms and conditions of this severance agreement. EXECUTED as of the date first written above.