JEFFERSON COUNTY PUBLIC SCHOOLS NOTIFICATION OF SUSPENSION WITHOUT PAY SUPPORT PERSONNEL
NAME, LAST, FIRST, M.I.
JOB TITLE
SOCIAL SECURITY NUMBER
WORK LOCATION
CONFERENCE DATE
This shall serve as official notification of SUSPENSION WITHOUT PAY for the period of time indicated below. This action is the result of performance deficiencies, problems, and/or other concerns cited on this form and discussed in a conference held on date above and summarized for inclusion in the personnel file. Failure to change/improve performance/behavior will result in further disciplinary action up to and including possible discharge.
DISCIPLINARY ACTION TAKEN SUSPENSION WITHOUT PAY EFFECTIVE: 5 WORK DAYS INDEFINITE (PENDING COMPLETION OF INVESTIGATION OR DECISION)
REASON FOR ACTION:
EXPECTATIONS FOR CHANGE/CONDITIONS OF PROBATION:
SUPERVISOR’S SIGNATURE
DATE
RECEIPT ACKNOWLEDGED (EMPLOYEE) EMPLOYEE'S COMMENTS (MAY BE CONTINUED ON BACK)
PERSONNEL FILE SUPERVISOR EMPLOYEE EMPLOYEE RELATIONS FORM SP (07/87)
RC:
APPROVAL SIGNATURE/DATE (WHEN REQUIRED)