HR Severance Agreement Intake Form
Employee Information
Employee Name
Employee ID
Department
Job Title
Date of Hire
Date of Termination
Severance Details
Reason for Separation
Layoff
Termination
Mutual Agreement
Other
Severance Amount
Severance Pay Period (weeks/months)
Additional Benefits
Approvals & Comments
HR Contact Name
HR Contact Email
Manager Name
Manager Email
Comments or Notes