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Disciplinary Notice

This is an employee disciplinary notice. The form provided here is simply a sample of what the actual form looks like.

DISCIPLINARY NOTICE

Employee __________________________________________

Department ____________________________________________

_____ Written Warning _____ Final Warning

1. Statement of the problem: __________________________________

__________________________________________________________

2. Prior discussion or warnings on this subject, whether oral or written: ___________

___________________________________________________________


3. Company policy on this subject: ___________________________________

_______________________________________________________________


4. Summary of corrective action to be taken by the Company and/or employee:

__________________________________________________________

__________________________________________________________

5. Consequences of failure to improve performance or correct behavior:

__________________________________________________________

__________________________________________________________

6. Employee Statement: ___________________________________

__________________________________________________________


Signed ___________________________________ (Employee)

Date: ___________________________________

Signed ___________________________________ (Supervisor)

Date: ___________________________________

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