DOL WAGE AND HOUR DIVISION SETTLEMENT AGREEMENT

IMPORTANT NOTICE: As of June 2025, the DOL Wage and Hour Division no longer seeks, negotiates, or accepts liquidated damages in pre-litigation administrative settlements pursuant to Field Assistance Bulletin 2025-3. This template reflects that policy change. Liquidated damages may still be pursued in court proceedings.

SETTLEMENT AGREEMENT AND RELEASE

WHD Case Number: [________________________________]

Employer/Company Name: [________________________________]

This Settlement Agreement and Release ("Agreement") is entered into by and between:

The United States Department of Labor, Wage and Hour Division ("DOL" or "Department")

and

[________________________________] ("Employer" or "Company")

(collectively referred to as the "Parties")

RECITALS

WHEREAS, the DOL conducted an investigation of Employer under WHD Case Number [________________________________] regarding compliance with the Fair Labor Standards Act, 29 U.S.C. § 201 et seq. ("FLSA"), for the period of [__/__/____] through [__/__/____] ("Investigation Period");

WHEREAS, the DOL alleges that the Employer violated provisions of the FLSA, including but not limited to:

☐ Section 6 (Minimum Wage) - 29 U.S.C. § 206
☐ Section 7 (Overtime) - 29 U.S.C. § 207
☐ Section 11(c) (Recordkeeping) - 29 U.S.C. § 211(c)
☐ Section 12 (Child Labor) - 29 U.S.C. § 212
☐ Other: [________________________________]

WHEREAS, the Employer [☐ admits / ☐ denies / ☐ neither admits nor denies] the allegations of violations but desires to resolve this matter without litigation;

WHEREAS, the DOL is authorized under 29 U.S.C. § 216(c) to supervise the payment of unpaid wages or unpaid overtime compensation owing to employees;

WHEREAS, the Parties desire to fully and finally resolve all matters arising from the Investigation without the need for litigation;

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:

ARTICLE I: BACK WAGES

1.1 Back Wage Amount

The Employer agrees to pay back wages in the total amount of $[________________________________] (the "Back Wage Amount") to the affected employees identified in Schedule A attached hereto and incorporated by reference.

1.2 Calculation of Back Wages

The Back Wage Amount represents:

☐ Unpaid minimum wages: $[________________________________]
☐ Unpaid overtime compensation: $[________________________________]
☐ Other: $[________________________________]

The Back Wage Amount covers the period from [__/__/____] to [__/__/____].

1.3 Distribution of Back Wages

The Back Wage Amount shall be distributed to the following employees:

[See Schedule A - Employee Back Wage Distribution]

1.4 Method of Payment

The Employer shall pay the Back Wage Amount as follows:

☐ Lump Sum Payment: Full payment within [____] days of execution of this Agreement

☐ Installment Payments:
- First installment: $[________________________________] due [__/__/____]
- Second installment: $[________________________________] due [__/__/____]
- Third installment: $[________________________________] due [__/__/____]
- [Additional installments as needed]

1.5 Payment Process

☐ Direct Payment by Employer: The Employer shall pay each affected employee directly by check payable to the employee, delivered [☐ in person / ☐ by mail] to the employee's last known address.

☐ Payment Through DOL: The Employer shall remit payment to the DOL for distribution to affected employees. Payment shall be made payable to "Wage and Hour Division, U.S. Department of Labor" and submitted to:

[________________________________]
[________________________________]
[________________________________]

1.6 Payroll Taxes

The Employer shall:

☐ Withhold applicable federal, state, and local income taxes from back wage payments
☐ Pay employer's share of FICA taxes on back wage payments
☐ Report back wage payments on employees' W-2 forms
☐ Make all required tax deposits

1.7 Proof of Payment

Within [____] days of making each payment, the Employer shall provide the DOL with:

☐ Copies of all checks issued to employees
☐ Proof of delivery or mailing
☐ Signed receipts from employees (if available)
☐ Documentation of any returned or undeliverable payments

ARTICLE II: CIVIL MONEY PENALTIES (If Applicable)

2.1 Civil Money Penalty Amount

☐ No civil money penalties are assessed as part of this Agreement.

☐ The Employer agrees to pay civil money penalties in the amount of $[________________________________] for the following violations:

2.2 Payment of Penalties

Civil money penalties shall be paid within [____] days of execution of this Agreement by check payable to "Wage and Hour Division, U.S. Department of Labor" and submitted to:

[________________________________]
[________________________________]
[________________________________]

ARTICLE III: COMPLIANCE COMMITMENTS

3.1 Future Compliance

The Employer agrees to comply with all provisions of the Fair Labor Standards Act, including but not limited to:

☐ Paying all employees at least the applicable minimum wage for all hours worked
☐ Paying all non-exempt employees overtime at 1.5 times the regular rate for hours over 40 per workweek
☐ Properly classifying employees as exempt or non-exempt
☐ Maintaining accurate records as required by 29 CFR Part 516
☐ Complying with child labor provisions (if applicable)
☐ Other: [________________________________]

3.2 Policy Review and Implementation

Within [____] days of execution of this Agreement, the Employer shall:

☐ Review and update wage and hour policies
☐ Review employee classifications for FLSA exemption status
☐ Review independent contractor classifications
☐ Implement a compliant timekeeping system
☐ Train supervisors on FLSA requirements
☐ Train employees on timekeeping procedures
☐ Post required FLSA notices

3.3 Compliance Monitoring

☐ The Employer agrees to permit DOL follow-up compliance monitoring for a period of [____] years from the date of this Agreement.

☐ The Employer agrees to submit quarterly compliance reports for [____] quarters following execution of this Agreement, documenting:
- Hours worked by non-exempt employees
- Overtime paid
- Changes to employee classifications
- Any complaints received

3.4 Compliance Officer Designation

The Employer designates the following individual as the FLSA Compliance Officer responsible for ensuring ongoing compliance:

Name: [________________________________]

Title: [________________________________]

Phone: ([____]) [____]-[____]

Email: [________________________________]

ARTICLE IV: RELEASES AND WAIVERS

4.1 DOL Release

Upon receipt of full payment of the Back Wage Amount [and civil money penalties, if applicable], the DOL agrees to release and discharge the Employer from any further claims, demands, or causes of action arising from the Investigation and the violations identified therein for the Investigation Period.

4.2 Scope of Release

This release applies only to:

☐ The violations identified in this Agreement
☐ The Investigation Period specified herein
☐ The affected employees identified in Schedule A

This release does not apply to:

☐ Violations occurring after the Investigation Period
☐ Violations not identified in this Agreement
☐ Future DOL investigations or enforcement actions
☐ Claims by employees who do not accept payment under this Agreement
☐ Claims for retaliation under 29 U.S.C. § 215(a)(3)

4.3 Employee Releases

☐ Option A - No Employee Releases Required:

Employees are not required to execute releases as a condition of receiving back wage payments.

☐ Option B - Employee Receipt and Release:

Employees shall execute the Receipt and Release form attached as Schedule B as a condition of receiving back wage payments.

4.4 No Admission of Liability

☐ This Agreement [does / does not] constitute an admission of liability by the Employer for any FLSA violations.

☐ The Employer enters into this Agreement solely for the purpose of resolving this matter without litigation.

ARTICLE V: WAIVER OF LIQUIDATED DAMAGES

5.1 Liquidated Damages

Pursuant to DOL Field Assistance Bulletin 2025-3, the DOL is not seeking liquidated damages in this administrative settlement.

☐ The Employer [has / has not] demonstrated good faith and reasonable grounds for believing that its actions did not violate the FLSA.

☐ This settlement reflects payment of back wages only, without liquidated damages.

5.2 Preservation of Employee Rights

Nothing in this Agreement shall be construed to preclude any affected employee from pursuing a private action for liquidated damages under 29 U.S.C. § 216(b).

ARTICLE VI: REPRESENTATIONS AND WARRANTIES

6.1 Employer Representations

The Employer represents and warrants that:

☐ It has the authority to enter into this Agreement
☐ The signatory is authorized to bind the Employer
☐ It has provided accurate information to the DOL during the Investigation
☐ It will make the payments required by this Agreement
☐ It will implement the compliance measures required by this Agreement

6.2 DOL Representations

The DOL represents that:

☐ The District Director/Area Director has authority to enter into this Agreement
☐ The Investigation has been conducted in accordance with applicable laws and regulations

ARTICLE VII: DEFAULT AND REMEDIES

7.1 Events of Default

The following shall constitute events of default:

☐ Failure to make any payment when due
☐ Failure to provide required documentation
☐ Failure to implement required compliance measures
☐ Material misrepresentation to the DOL
☐ Violations of the FLSA during the compliance monitoring period

7.2 Notice of Default

The DOL shall provide written notice of default to the Employer, specifying the nature of the default and allowing [____] days to cure.

7.3 Remedies Upon Default

If the Employer fails to cure a default within the cure period, the DOL may:

☐ Pursue litigation to enforce this Agreement
☐ Seek liquidated damages in addition to unpaid back wages
☐ Refer the matter to the Solicitor of Labor for litigation
☐ Seek additional civil money penalties
☐ Take other enforcement action as authorized by law

ARTICLE VIII: GENERAL PROVISIONS

8.1 Entire Agreement

This Agreement, including all attached Schedules, constitutes the entire agreement between the Parties and supersedes all prior negotiations, representations, or agreements relating to the subject matter hereof.

8.2 Amendment

This Agreement may not be amended except in writing signed by both Parties.

8.3 Severability

If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.

8.4 Governing Law

This Agreement shall be governed by and construed in accordance with federal law, including the Fair Labor Standards Act.

8.5 Notices

All notices required or permitted under this Agreement shall be in writing and delivered to:

To DOL:

U.S. Department of Labor
Wage and Hour Division
[________________________________]
[________________________________]
Attn: [________________________________]

To Employer:

[________________________________]
[________________________________]
[________________________________]
Attn: [________________________________]

8.6 Counterparts

This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.

8.7 Headings

The headings in this Agreement are for convenience only and shall not affect the interpretation of this Agreement.

EXECUTION

IN WITNESS WHEREOF, the Parties have executed this Agreement as of the dates set forth below.

U.S. DEPARTMENT OF LABOR, WAGE AND HOUR DIVISION

Signature: _______________________________________

Name: [________________________________]

Title: [________________________________]

Date: [__/__/____]

EMPLOYER

Company Name: [________________________________]

Signature: _______________________________________

Name: [________________________________]

Title: [________________________________]

Date: [__/__/____]

SCHEDULE A: EMPLOYEE BACK WAGE DISTRIBUTION

TOTAL BACK WAGES: $[________________________________]

Total Number of Affected Employees: [____]

SCHEDULE B: EMPLOYEE RECEIPT AND RELEASE (Optional)

RECEIPT OF BACK WAGES AND RELEASE

I, [________________________________], acknowledge that I have received payment in the amount of $[________________________________] from [________________________________] ("Employer") representing back wages owed to me for the period of [__/__/____] to [__/__/____] as a result of the U.S. Department of Labor investigation (WHD Case No. [________________________________]).

☐ I understand that this payment represents:

☐ Unpaid minimum wages: $[________________________________]
☐ Unpaid overtime compensation: $[________________________________]
☐ Other: $[________________________________]

☐ I understand that applicable taxes have been withheld from this payment.

☐ I understand that by accepting this payment, I am releasing the Employer from any claims for unpaid wages covered by this payment for the period specified above.

☐ I understand that this release does not affect any claims I may have:
- For periods not covered by this payment
- For liquidated damages under 29 U.S.C. § 216(b)
- For retaliation under 29 U.S.C. § 215(a)(3)
- Under state wage and hour laws

Employee Signature: _______________________________________

Employee Name (Print): [________________________________]

Date: [__/__/____]

Social Security Number (Last 4 digits): XXX-XX-[____]

Current Address:
[________________________________]
[________________________________]

Witness Signature: _______________________________________

Witness Name (Print): [________________________________]

Date: [__/__/____]

SCHEDULE C: PAYMENT VERIFICATION FORM

Employer Certification of Back Wage Payment

I certify that [________________________________] ("Employer") has made the following back wage payments in accordance with the Settlement Agreement dated [__/__/____]:

Total Amount Paid: $[________________________________]

Remaining Balance Due: $[________________________________]

☐ Copies of all checks attached
☐ Proof of delivery/mailing attached
☐ Signed employee receipts attached (if obtained)

Employer Representative Signature: _______________________________________

Name: [________________________________]

Title: [________________________________]

Date: [__/__/____]

SOURCES AND REFERENCES

• 29 U.S.C. § 216 - Penalties
• 29 U.S.C. § 260 - Liquidated Damages
• DOL Field Assistance Bulletin 2025-3 (Liquidated Damages Policy)
• DOL PAID Program
• DOL Wage and Hour Division

This template is provided for informational purposes only. Settlement agreements with the DOL should be negotiated and finalized with the assistance of qualified legal counsel.