Employee Notice Of Discipline Page 3

EMPLOYEE WRITTEN WARNING

Employee

Work Location

Date of Discipline Action Given

Employee ID #

Date of Occurrence

Supervisor Issuing Action

This shall serve as a written warning for above employee.

Statement of Violation(s):

Corrective Actions needed to take place by employee:

Amount of time allowed for improvement:

I understand the above violations and have discussed them with my supervisor/program

coordinator/director and agree to take steps to meet the corrective actions in a timely manner.

Employee refused to sign this form and all attached documentation

Employee’s Signature___________________________________________

Date__________________

Supervisor’s Signature___________________________________________

Date__________________

Witness’s Signature_____________________________________________

Date__________________

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Parent category: Business