Document text
[YOUR FULL NAME]
[YOUR ADDRESS] · [YOUR EMAIL] · [YOUR PHONE]
[DATE]
To: [NAME OF HR CONTACT], [TITLE]
[COMPANY NAME]
[COMPANY ADDRESS]
Re: Separation agreement dated [DATE OF THE AGREEMENT] — counter-proposal
Dear [NAME],
Thank you for the separation agreement you gave me on [DATE RECEIVED]. I have reviewed it and I would like to propose the following changes before I sign.
Item Your offer My proposal
Severance pay [WEEKS] weeks — $[AMOUNT] [WEEKS] weeks — $[AMOUNT]
Unused PTO payout $[AMOUNT] $[AMOUNT]
Bonus or commission earned $[AMOUNT] $[AMOUNT]
COBRA premiums paid by the company [MONTHS] months [MONTHS] months
Reference and departure statement [AS OFFERED] [NEUTRAL REFERENCE, AGREED WORDING]
Non-compete / non-solicit [AS OFFERED] [REMOVED OR LIMITED TO …]
My reasons:
1. [YEARS] years of service in [ROLE], including [ONE OR TWO RESULTS WITH NUMBERS].
2. [E.G. THE TIME IT USUALLY TAKES TO FIND A SIMILAR ROLE IN MY FIELD.]
3. [E.G. THE BONUS FOR THE PERIOD ALREADY WORKED.]
I would appreciate a written reply by [DATE]. I remain available to help with a smooth handover of my work.
Sincerely,
______________________________
[YOUR FULL NAME]
Review checklist — before you sign
The money
☐ Severance amount and how it is calculated (weeks per year of service)
☐ When and how it is paid: lump sum or salary continuation; tax withholding
☐ Final paycheck, unused PTO, earned bonus and commission — included or separate
☐ Expense reimbursements still owed
Benefits
☐ Date your health coverage ends
☐ COBRA: who pays the premium and for how many months; 60 days to elect
☐ 401(k), stock options or RSUs: vesting and deadlines to exercise
The release
☐ Which claims you give up; claims after the signing date cannot be released
☐ You keep the right to file a charge with the EEOC and to take part in its investigation
☐ Age 40+: the agreement names the ADEA, advises you in writing to consult an attorney, gives at least 21 days (45 in a group layoff) and 7 days to revoke
☐ Group layoff, age 40+: list of job titles and ages of people selected and not selected
Other clauses
☐ Non-compete, non-solicit, confidentiality, non-disparagement — scope and length
☐ Reference: who answers and what they say
☐ Return of company property and the date
☐ Unemployment benefits: the agreement does not stop you from applying
Dates
Offer received: [DATE] · Review period ends: [DATE] · Signed: [DATE] · Revocation ends: [DATE]
Health coverage ends: [DATE] · COBRA election deadline: [DATE]
This checklist and letter are not legal advice. For your own case, talk to an employment lawyer.
Reply to this document or get a deadline reminder: https://layers.md/us/severance-agreement-review-checklist?from=reply-us-severance-review