Employee Disciplinary Action Form Sample - PDF - PDF by yon21089

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									                     Employee Disciplinary Action Form Sample

Prior to taking any disciplinary action, this routing form and all documents regarding the
proposed disciplinary action must be reviewed by the Human Resources Manager for
policy compliance, technical accuracy and legal defensibility.

Employee’s Name: …………………………………………………….

Program/Department: ………………………………………………….

Classification (full-time/part-time/ casual):……………………………

Date: …………………………………………………………………..

Recommended Disciplinary Action Category (check those which apply):
   • Unsatisfactory Job Performance
   • Grossly Inefficient Job Performance
   • Unacceptable Personal Conduct

Details:

……………………………………………………………………………….
……………………………………………………………………………….
……………………………………………………………………………….
………………………………………………………………………………

Type Action Recommended: (check one)

Written Warning                              Effective date: ……………….
Disciplinary Suspension without Pay          Effective date: ……………….
Demotion                                     Effective date: ……………….
Dismissal                                    Effective date: ……………….

Signature of supervisor/manager issuing disciplinary action

…………………….

Date: ………………….

Human Resource Manager ………………………..




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