Settlement Agreement Samples and Forms

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Agencies entering into Settlement Agreements with classified employees must only do so with the Division of Personnel's (DOP) review and approval. Please refer to the Settlement Agreements/Back Wages policy and the Settlement Agreement & Payroll Correction Payment Request Form Checklists​ before submitting a proposed Settlement Agreement or Payroll Correction Payment Request Form for a DOP review. The following sample documents are provided to assist you with format and language. In order to expedite the approval process, please provide the DOP with an electronic draft document, when possible, with the employee name in the subject line of the email for optimal tracking purposes.​​

An Introduction to Settlement Agreements/Back Wages - online course.​

Note: These sample documents are View Only. To create your own editable copy, Select File > Make a copy or File > Download.  Make a copy will create an editable copy in your personal Google Drive. The download option will download an editable Word version to your desktop.​

• Settlement Agreement Sample - Classification
  
• Settlement Agreement Sample - Classification (DOP Joined)
• Settlement Agreement Sample - Dismissal
  
• Settlement Agreement Sample - Suspension
• Settlement Agreement Sample - Temporary Upgrade (No Grievance Filed)​
• Payroll Correction Payment Request Form
  
• Settlement Agreement​ & Payroll Correction Pa​yment Request Form Checklists - Updat​ed October 2022​
  

Call Employee Relations at 304-414-1853 if you need additional assistance with the documents.