2414 Bull Street Columbia, South Carolina 29202
NOTICE OF SUSPENSION
Prepare in triplicate. Distribute original to employee, duplicate to HRS and triplicate to Field Personnel Folder.
Name Facility / Center / Division Position Title Organizational Component The Human Resource Services Director or Designee consulted: (*See “Employee Disciplinary Standards”) Social Security No.
*
Name Date 1. Reason(s) for Suspension: (Details of the offense / dates of counseling, and written warnings if applicable.)
(CONTINUE ON REVERSE SIDE IF NECESSARY)
2. Inclusive Dates of Suspension:
3. Consequences of Future Violations or Misconduct:
4. Employee Comments:
Type / Print Name of Supervisor Taking Action Signature of Supervisor Taking Action Date
Signature indicates that I have received and understand this Notice of Suspension
Signature of Employee Signature of Witness (if applicable) Date
REV. FEB. 2001
HRS154
(CG - Forms Mgmt. 9/1998) Rec. Sched. MH-AHRS-PBS
D:\DOCSTOC\WORKING\PDF\7FA3872D-70E8-4666-B77C-1BCACB0B0D6B.DOC