Cal Poly Pomona Foundation, Inc - DOC by dE3ybJz


									                                                       Cal Poly Pomona Foundation, Inc

                                             EMPLOYEE DISCIPLINARY ACTION

Employee Name                        Classification            Department

Date of Conduct                     Time of Conduct             am/pm Date of Disciplinary Action

Level of Discipline              Coaching/            Verbal          Written            Suspension   Termination

Description of the inappropriate conduct/behavior: (attach additional memo if applicable)

Names of other persons involved:

Names of any witnesses:

Describe any mitigating circumstances:

Expected conduct/behavior (if applicable):

Response from employee:

This discipline measure is given to you so that you may have an opportunity to correct the situation. You are encouraged to
respond in the area provided above. Your signature only verifies that you have received this disciplinary action and does not
necessarily indicate your agreement. Further inappropriate conduct/behavior may subject you to additional disciplinary
measures up to and including immediate termination.

I have read and understand this discipline action and understand what is expected of me to correct the situation.

___________________________________________                                 ______________________________________________
Employee Signature               Date                                       Supervisor Signature, Title             Date

                                                                            Witness Signature, Title                Date

Distribution: Original/Human Resources       Copy/Supervisor         Copy/Employee                      Revised 05/07

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