Unauthorized Leave And Written Warning Template (Page 2 of 3) in pdf

If your [specify issue] is the result of medical and/or personal problems, I suggest you may want to

contact the physician, practitioner, or counseling service of your choice. Whether or not you choose to

do so is your decision. I am, however, obligated to ensure that you [report for duty as scheduled,

observe established rules, meet performance expectations, etc.]. You may also obtain information on

the State of West Virginia’s Employee Referral Program by contacting the Division of Personnel at (304)

558‐3950,

extension

57247,

visiting

the

web

site

For any appeal rights you may have, please refer to W. V

. C

§6C‐2‐1 et seq., the West Virginia Public

ODE

Employees Grievance Procedure. If you choose to exercise your grievance rights, you must submit your

grievance, on the prescribed form, within fifteen (15) working days of the effective date of this action, to

[name and address of Chief Administrator] at Level One of the Procedure. As provided in the statute,

you may proceed to Level Three of the Procedure by filing your grievance directly with the Public

Employees Grievance Board upon the agreement of the chief administrator, or when dismissed,

suspended without pay, or demoted or reclassified resulting in a loss of compensation or benefits. You

must provide copies of your grievance accordingly to the Public Employees Grievance Board at 1596

Kanawha Boulevard, East, Charleston, West Virginia, 25311; [agency copy ‐ name and address]; and the

Director of the Division of Personnel, Building 6, Room B‐416, State Capitol Complex, Charleston, West

Virginia, 25305. Details regarding the grievance procedure, as well as grievance forms, are available at

the Board’s web site at or you may telephone the Board at (304) 558‐3361 or toll‐

free at (866) 747‐6743.

Please sign one copy of this letter indicating your receipt of this notice of the pay dock and written

reprimand, and return to me. Your signature does not indicate agreement or disagreement with the

contents; it only verifies that you have received this letter. A copy will also be placed in your

confidential agency Personnel File.

Sincerely,

[Appropriate Signature Authority ]

Attachment

c: Agency Personnel File

West Virginia Division of Personnel

[OPTIONAL LANGUAGE ‐ If the employer meets with the employee and hand delivers the letter, the

employer may request that the employee verify receipt by signing the following acknowledgment

typed at the bottom of the letter.]

I have received a copy and am aware of the contents of the foregoing letter

___________________________________

__________________

Employee Signature

Date

Unauthorized Leave And Written Warning Template Page 2

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