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Lay Off Request Form

Please complete the form below to submit a layoff request.
We will review the request and provide feedback regarding the recommended next steps.

* Indicates a required field
Company Name *
Employee Name *
Employee Email *
Manager / Supervisor Name *
Manager / Supervisor Email *
Date of Request *
Last Day of Employment *
Is the employee in any of the protected classes listed below? *
If Other, please provide description
Why is the company conducting a layoff? *
How many employees are being laid off? How did you select which employee(s) would be laid off? *
Are you providing the employee with a severance payment and agreement? *
If Other, please provide description
Is the employee eligible for rehire? *
Please include any additional information you would like to provide about this lay off.
When you click “Submit,” you are confirming that you agree (1) information you submit will be protected and (2) used as permitted in our privacy policy and terms. If you do not agree to any of these terms, you may not submit this form.
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