EMPLOYEE DISCIPLINARY NOTICE
SECTION 1.
Employee Name Work Number Department Name
Please check one
Date SAP Number Employee’s Position
WARNING:
Oral (remains in Dept., documentation only)
Immediate Dismissal Employee’s Last Day is
Written (Send to Human Resources to put in Personnel File)
Purpose of the warning: (Explain in detail. If additional space is needed, use blank paper and prepare in triplicate.)
/
Supervisor’s Signature Date
/
Department Head’s Signature Date
SECTION 2. This section is ONLY completed if the employee receives a Written Warning or for Immediate Dismissal (not required for an Oral Warning).
(The employee must check the appropriate statement below, or the supervisor should state in the comment section that the employee refused to sign this notice.) ____ I did read the above notice and agree. I understand that the purpose for this warning was accurately and fairly described above. ____ I did read the above notice but disagree. I understand that I have 10 day to advance this issue to grievance proceedings. I also understand that it is my responsibility to contact the Assistant Vice Chancellor for Employee Relations for processing.
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Employee's Signature Date
COMMENTS:
/
Signature of Individual Expressing Comments Date
Date received by Human Resources:_________ Reviewed by:_______________________
Make 3 copies: (1) HR/Personnel; (2) Department; (3) Employee
CODE:_____