Fillable Discipline-Form-2015 Discipline Form UPDATED

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Discipline-Form-2015 Discipline Form UPDATED

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U.S.A. forms for Wilkes University

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Revised 03/2015
Record of Employee Disciplinary Action
Employee Information
Employee Name:
Supervisor:
Job Title:
Department:
Type of Warning
Verbal
Written
Suspension ________Days
Details
Description of Issue:
Include all relevant information (Date, Time, Policy Violation if applicable, etc.)
Previous Disciplinary
Action (if relevant):
For:
Specific changes in performance or behavior required and the time frame in which they must occur:
Please note: Failure of employee to correct problem may result in further disciplinary action up to
and including termination of employment.
Acknowledgement of Receipt of Warning
Your signature confirms that you understand the information in this warning. You are acknowledging: that your
supervisor has discussed the warning with you; the specific changes that must occur; and the potential
consequences if you fail to make the changes. Your signature is not an indication of agreement or disagreement of
the issues outlined in this document.
Employee Signature:
Date:
Supervisor Signature:
Date:
Witness Signature (if employee refuses to sign):
None
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Discipline-Form-2015 Discipline Form UPDATED

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Completed 15 November 2019

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