This Employee Acknowledgements Regarding Termination of Employment document is
to be used by employers upon the termination of an employee. The document sets forth
acknowledgements by the employee that his or her employment is being terminated and
evidences that the employee has returned all company property to the employer. It also
acknowledges that the employee may still be bound by non-compete or non-disclosure
provisions following the termination of employment. This document contains numerous
standard provisions and may be customized to fit the specific needs of the parties.
Employee Acknowledgements re: Termination of
Employment
I acknowledge by signing below that my at will employment with ____________________
[Instruction: insert name of employer] will terminate on ______________________
[Instruction: insert date employment will end] at _______ [a.m./p.m.] [Instruction: insert
time of day that employment will end] (“Termination Date”) [Instruction: choose one of the
following] (1) and that such termination of employment is at my own request. OR (2) and that
such termination is at the decision of ____________________ [Instruction: insert name of
employer].
Further, as evidenced by my signature below, I confirm that I have returned and that I do not
retain in my possession any property in any form belonging to ____________________
[Instruction: insert name of employer] including, but not limited to, property meeting the
following descriptions: trade secrets, secret, private, confidential or proprietary information,
customer lists, equipment, computers, laptops, servers, phones, digital storage devices,
documents and materials or tools. I additionally confirm that if any property belonging to
____________________ [Instruction: insert name of employer], including, but not limited to
the property described in the preceding sentence, was saved or retained or otherwise stored on
any computers, laptops, digital storage devices, servers, phones, equipment or tools, owned by
me, such property has been permanently deleted or otherwise permanently removed and originals
or copies, whether digital or in hardcopy form, are not being retained by me.
I acknowledge that I have during the term of my employment with ____________________
[Instruction: insert name of employer] and that I will continue to abide by and comply with all
terms of employment connected to my employment with ____________________ [Instruction:
insert name of employer] and I acknowledge that I may have continuing duties to refrain from
engaging in certain activities after the Termination Date pursuant to agreements entered into by
me with ____________________ [Instruction: insert name of employer] at the commencement
of and during the term of my employment, including, but not limited to, non-compete
agreements, no solicitation agreements and non-disclosure agreements.
Notwithstanding the existence of any additional agreements regarding the preservation and non-
disclosure of confidential, proprietary, private, secret and trade-secret information belonging to
and about ____________________ [Instruction: insert name of employer], I agree that I will
preserve the confidential, proprietary, private and secret nature of such information and I will not
disclose such information unless compelled to do so under court order.
I freely and voluntarily enter into this agreement as is evidenced by my signature below.
© Copyright 2012 Docstoc Inc. 2
I acknowledge that I have received a copy of this agreement.
I declare under penalty of perjury that the foregoing is true and correct.
Date: ____________
________________________________________
____________________________ [Instruction: insert name of employee]
© Copyright 2012 Docstoc Inc. 3
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