|
Your Name – enter your name or nickname as you want it displayed |
|
|
Name of Business |
|
|
Primary area of practice |
please specify field of law here:
|
|
2nd area of practice: (optional) |
please specify field of law here:
|
|
3rd area of practice: |
please specify field of law here:
|
|
4th area of practice: |
please specify field of law here:
|
|
5th area of practice: |
please specify field of law here:
|
|
Location – where you practice law (fill in as many fields as you
would like) |
|
|
|
Note: your profile does not go live until
you contribute a form
|
|
Click image below to see how we display your
profile
|
- Receive a free profile listing your firm's areas of expertise
- All contributed forms prominently display your business profile,
which include the optional fields of your phone number, email, and website address(see
example in top right)
- Connect with thousands of businesses, professionals, and potential
customers looking to use your expertise and services
- Your form will be highly optimized for the search engines, enabling people doing
keyword searches related to your business to find you via the profile we display
about you
- Feel good by giving back to the community by providing quality legal and business
forms for free
- You're protected: all users who download your forms agree to idemnify you Learn More
|
|
|
Your Name – enter your name or nickname as you want it displayed |
|
|
Name of Business |
|
|
2nd area of practice: (optional) |
please specify field of law here:
|
|
3rd area of practice: |
please specify field of law here:
|
|
4th area of practice: |
please specify field of law here:
|
|
5th area of practice: |
please specify field of law here:
|
|
Location – where you practice law (fill in as many fields as you
would like) |
|
|
|
Note: your profile does not go live until
you contribute a form
|
|
Click image below to see how we display your
profile
|
- Receive a free profile listing your firm's areas of expertise
- All contributed forms prominently display your business profile,
which include the optional fields of your phone number, email, and website address(see
example in top right)
- Connect with thousands of businesses, professionals, and potential
customers looking to use your expertise and services
- Your form will be highly optimized for the search engines, enabling people doing
keyword searches related to your business to find you via the profile we display
about you
- Feel good by giving back to the community by providing quality legal and business
forms for free
- You're protected: all users who download your forms agree to idemnify you Learn More
|
|
|
Your Name – enter your name or nickname as you want it displayed |
|
|
Name of Business |
|
|
2nd area of practice: (optional) |
please specify field of law here:
|
|
3rd area of practice: |
please specify field of law here:
|
|
4th area of practice: |
please specify field of law here:
|
|
5th area of practice: |
please specify field of law here:
|
|
Location – where you practice law (fill in as many fields as you
would like) |
|
|
|
Note: your profile does not go live until
you contribute a form
|
|
Click image below to see how we display your
profile
|
- Receive a free profile listing your firm's areas of expertise
- All contributed forms prominently display your business profile,
which include the optional fields of your phone number, email, and website address(see
example in top right)
- Connect with thousands of businesses, professionals, and potential
customers looking to use your expertise and services
- Your form will be highly optimized for the search engines, enabling people doing
keyword searches related to your business to find you via the profile we display
about you
- Feel good by giving back to the community by providing quality legal and business
forms for free
- You're protected: all users who download your forms agree to idemnify you Learn More
|
|
|
Our Spam Policy
We hate getting spam as much as you do. So we have implemented a tough spam policy
regading how we deal with your email. We pledge that we will:
- Never rent, trade, or sell any email or any personal information to any third
party without your explicit consent
Terms Of Use
Submissions to this site, including any legal or business forms, posts, responses
to questions or other communications by contributors are not intended as and should
not be construed as legal advice. You are strongly encouraged to consult competent
legal council before engaging in any action based upon content contained on this
site.
These downloadable forms are only for personal use. Retransmission, redistribution,
or any other commercial use is prohibited. This includes reposting forms from this
site to another site offering free legal or other document forms for download.
Please note that the donator may have included different usage terms regarding this
form, and you agree to abide by these terms. It is highly recommended that you have
a licensed attorney review any legal documents for which you are searching in order
to make sure that your needs are being properly and completely satisfied.
Your use of this site constitutes your acceptance of our terms of use and your agreement
to hold this site, its officers, employees and any contributors to this site harmless
for any damage you might incur from your use of any submissions contained on this
site. If you do not agree to the above terms, please do not proceed.
These forms are provided to assist business owners and others in understanding important
points to consider in different transactions. They are offered with the understanding
that no legal advice, accounting, or other professional service is being offered
by these documents or on this website. Laws vary in the different states. Agreements
acceptable in one state may not be enforced the same way under the laws of another
state. Also, agreements should relate specifically to the particular facts of each
situation. Therefore, it is important to consult legal counsel whenever utilizing
these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com
is not engaged in recommending or referring members on the site or making claims
about the competence, character or qualifications of its participating members.
Close
Thank you for using
Yourfreelegalforms.com
Your online source for 100% free legal and business forms.
Have a form to contribute?
Contribute a legal or business form, checklist or article and have your profile
displayed on the same page as the form for free, powerfull, targeted marketing to
those searching for legal forms and advice.
Rate this form
(must be logged in)
|
|
Social Bookmark this Form
|
|
|
Advertise your business to thousands for free –
Contribute a form
|
|
Form #668Employee's Release - Personal Injury Claims
|
Average user rating: |
Not Yet Rated
|
Rate it |
|
Employee's Release - Personal Injury Claims (free form to use)
|
Need this form customized? |
Download This Form
|
Printer Friendly Version
Terms Of Use
Submissions to this site, including any legal or business forms, posts, responses
to questions or other communications by contributors are not intended as and should
not be construed as legal advice. You are strongly encouraged to consult competent
legal council before engaging in any action based upon content contained on this
site.
These downloadable forms are only for personal use. Retransmission, redistribution,
or any other commercial use is prohibited. This includes reposting forms from this
site to another site offering free legal or other document forms for download.
Please note that the donator may have included different usage terms regarding this
form, and you agree to abide by these terms. It is highly recommended that you have
a licensed attorney review any legal documents for which you are searching in order
to make sure that your needs are being properly and completely satisfied.
Your use of this site constitutes your acceptance of our terms of use and your
agreement to hold this site, its officers, employees and any contributors to this
site harmless for any damage you might incur from your use of any submissions contained
on this site. If you do not agree to the above terms, please do not proceed.
These forms are provided to assist business owners and others in understanding important
points to consider in different transactions. They are offered with the understanding
that no legal advice, accounting, or other professional service is being offered
by these documents or on this website. Laws vary in the different states. Agreements
acceptable in one state may not be enforced the same way under the laws of another
state. Also, agreements should relate specifically to the particular facts of each
situation. Therefore, it is important to consult legal counsel whenever utilizing
these forms. The Forms are not a substitute for legal advice. YourFreeLegalForms.com
is not engaged in recommending or referring members on the site or making claims
about the competence, character or qualifications of its participating members.
|
EMPLOYEE'S
RELEASE
PERSONAL
INJURY CLAIMS
Release executed on _______________________
(month & day), _________ (year), by ___________________________ (name)
___________________________________
(address), here referred to as
releasor, to ____________________________________ (name), a corporation
incorporated under the laws of the State of _________________, of (or, if a
corporation: with its principal place of business located at) ______________
______________________________________
(address), here referred to as company.
RECITALS
A. Releasor has been employed by company
as a ____________________________ (set forth job title or description) since
______________________ (month & day), _________ (year), and __________
(earns the sum of ____________________ Dollars ($_________) per week or set
forth average weekly wage as determined under workers compensation law).
B. On _____________________ (month
& day), _________ (year), releasor sustained personal injuries, including
________________________________________________ ______________ (enumerate), as
a result of an accident that occurred as follows:
_____________________________________________________________ (describe).
C. The above-described personal
injuries are ________________ (total or partial) and have been determined to be
_________________________ (permanent or temporary) in nature.
D. Prior to the date of this
release, ______________________ (month & day), ______ (year), the sum of
__________________ Dollars ($__________) has been paid (or is due and unpaid)
to releasor as benefits under the _________________ (state) workers
compensation law or otherwise as the case may be). The sum of
__________________ Dollars ($__________) in additional payments is to be made
to releasor, such payments continuing until ________________________ (month
& day), ___________ (year), or for a period of ____________ weeks.
E. __________ (In the event of a
claim or lien for unemployment benefits, the number of days and the amount of
temporary disability indemnity for which a lien should be allowed should be set
out.)
F. Releasor is willing to release
company from all claims that ____________ (he/she) may have in relation to the
above-described personal injuries according to the terms of this instrument.
SECTION ONE
RELEASE OF
ALL CLAIMS
In consideration of the sum of
____________ Dollars ($__________ ), receipt of which from company is hereby
acknowledged, releasor executes this release in full settlement of all claims
as hereinafter set forth for ______________________ (himself/herself), and
____________ (his/her) dependents, heirs, legal representatives and assigns,
releasor forever releases and discharges company, its agents, officers,
employees, successors and assigns, of and from any and all claims, demands,
actions and causes of action or suits at law or in equity for and on account of
any and all known and unknown injuries, disabilities, physical and mental,
diseases, damages, losses and expenses sustained by _____________ (him/her) or
anyone claiming under ____________ (him/her) as a result of the above-described
accident. Releasor intends that this release apply to any and all future
injuries, damages, losses and expenses, not now known or anticipated, but as
may later develop or be discovered, with all the effects and consequences
thereof, arising out of the above-described accident.
SECTION TWO
WORKERS
COMPENSATION
This release shall fully and
completely settle, satisfy and discharge all of releasor’s claims, demands,
actions and causes of action against the parties hereby discharged under the
Workers Compensation Law of the State of ______________________, or any other
law, arising or to arise from the above-described accident.
SECTION THREE
MEDICAL
EXPENSES
All medical, hospital and other
related expenses, and all future medical, hospital and other related expenses
that may be incurred by releasor or any person in ___________ (his/her) behalf
in connection with the above-described accident are the sole and separate
obligation of releasor, and the parties named herein are released and
discharged from any and all liability therefor.
SECTION FOUR
RELIANCE FOR
EXECUTION OF RELEASE
Releasor
states that no other promises have been made or other considerations promised
for the execution of this release and settlement. Releasor executes this
release of _____ (his/her) own volition and free
will and not on the advice or
statement of any physician, attorney or other person in any way connected with
the parties herein discharged as to any past, present or future condition of
fact of any kind or character whatever.
Releasor has read this release and
fully understands all its terms.
SECTION FIVE
APPROVAL
Releasor and company agree that this
release will not be effective unless and until it has been approved by
______________________________________________ (specify workers compensation
appeals board or by a referee).
In witness whereof, releasor executes
this release at ____________________ (designate place of execution) on the day
and year first above written.
_____________________________________ ____________________
(Signature) (Date)
(Acknowledgment)
Approved as to Form and Content By:
_____________________________________ ____________________
(Signature and Title of Official)
(Date)
Our Spam Policy
We hate getting spam as much as you do. So we have implemented a tough spam policy
regading how we deal with your email. We pledge that we will:
- Never rent, trade, or sell any email or any personal information to any third
party without your explicit consent
Terms Of Use
Submissions to this site, including any legal or business forms, posts, responses
to questions or other communications by contributors are not intended as and should
not be construed as legal advice. You are strongly encouraged to consult competent
legal council before engaging in any action based upon content contained on this
site.
These downloadable forms are only for personal use. Retransmission, redistribution,
or any other commercial use is prohibited. This includes reposting forms from this
site to another site offering free legal or other document forms for download.
Please note that the donator may have included different usage terms regarding this
form, and you agree to abide by these terms. It is highly recommended that you have
a licensed attorney review any legal documents for which you are searching in order
to make sure that your needs are being properly and completely satisfied.
Your use of this site constitutes your acceptance of our terms of use and your agreement
to hold this site, its officers, employees and any contributors to this site harmless
for any damage you might incur from your use of any submissions contained on this
site. If you do not agree to the above terms, please do not proceed.
These forms are provided to assist business owners and others in understanding important
points to consider in different transactions. They are offered with the understanding
that no legal advice, accounting, or other professional service is being offered
by these documents or on this website. Laws vary in the different states. Agreements
acceptable in one state may not be enforced the same way under the laws of another
state. Also, agreements should relate specifically to the particular facts of each
situation. Therefore, it is important to consult legal counsel whenever utilizing
these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com
is not engaged in recommending or referring members on the site or making claims
about the competence, character or qualifications of its participating members.
Close
Thank you for using
Yourfreelegalforms.com
Your online source for 100% free legal and business forms.
Have a form to contribute?
Contribute a legal or business form, checklist or article and have your profile
displayed on the same page as the form for free, powerfull, targeted marketing to
those searching for legal forms and advice.
Rate this form
(must be logged in)
|
|
Social Bookmark this Form
|
|
Keywords: Employee's Release, Personal Injury Claims, legal forms
|
|
|