This is a document used by an employer to notify an employee that he or she is being
dismissed. The notice provides the reasons for dismissal, the date of the dismissal, the
date of the final paycheck, health benefits termination, termination pay, and a release
form attached under a fully customizable â€œExhibit A.â€ This document should be used by
small businesses or other entities that want to record the details of dismissing an
NOTICE OF DISMISSAL
_____ [Month] _____ [Date], 20_____
________________________ [Instruction: Insert the employee name]
________________________ [Instruction: Insert the company]
________________________ [Instruction: Insert the employee address]
We regret to notify you that your employment with the firm shall be terminated on _____
[Month] _____ [Date], 20____, because of the following reasons:
[Instruction: Please detail the reasons for the termination of the employee in above
You will receive your regular pay up to and including today, _____________ [Date].
(IF APPLICABLE) You will receive an additional _____________ [Comment: this will
depend upon the Record] number of weekâ€™s pay in lieu of notice of termination as per our
obligations under the _________________ Code, _____________.
(IF APPLICABLE) Your entitlement to our group health benefits program will continue during
your notice period, with the exception of [depends on the plan], which ceases effective
You will receive a further payment which will represent your accrued and owing vacation pay.
These payments together with your record of employment will be delivered to you within
___________ (___) [â—Šten (10)] days of todayâ€™s date.
Â© Copyright 2012 Docstoc Inc. 2
(IF APPLICABLE) We wish to amicably and completely bring closure to your employment
and to assist you in this transition. We are therefore prepared to offer you an additional
___________ (___) [â—Štwo (2)] weeks of termination pay, to be paid to you in a lump sum, less
applicable statutory withholdings. Please note that this offer is conditional upon you keeping its
terms strictly confidential, with the exception of your legal counsel. This offer will remain in
force for your consideration until _____ [Month] _____ [Date], 20_____
If the terms of this separation offer are acceptable to you, please sign below and attach a signed
and witnessed copy of the attached Release Form as Exhibit A. When you have signed, the
terms of this letter will become a binding agreement upon you and ________________________
[Instruction: Insert the company].
We deeply regret the need for this action.
cc: [List carbon copy name(s)]
Â© Copyright 2012 Docstoc Inc. 3
Â© Copyright 2012 Docstoc Inc. 4
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