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 review and approval. Please refer to the Settlement Agreement Policy before submitting a proposed settlement for review. The following Settlement Agreement sample documents are provided to assist you with format and language. Be sure to pay attention to all page headers so they end up in the proper places.​

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 Checklist - Updated October 2022​
  

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