Fillable Employee Disciplinary Form (Mississippi Delta Community College)

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Employee Disciplinary Form (Mississippi Delta Community College)

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The Employee Disciplinary Form (Mississippi Delta Community College) form is 1 page long and contains:

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Page 1 of 2
Employee Disciplinary Form
Employee Name
Date
Employee ID No.
Department
Job Title ____________________________________ Supervisor’s Name ____________________________________
Level of Offense
First Warning Second Warning Final Warning
Type of Offense
Absenteeism
Insubordination
Tardiness/Leaving Early
Violation of Company Policies
Violation of Safety Rules
Other (specify) _____________________________________________________________________________________________
Details
Description of Infraction:
Plan for Improvement:
Consequences of Further Infractions:
Moorhead Campus
Greenville Center
Greenwood Center
Indianola Center
Employee Information
Page 2 of 2
Acknowledgement of Receipt
By signing this form below, you confirm that you understand the disciplinary action noted above. You also confirm that you and your
immediate supervisor have discussed the matter and a plan for improvement. Signing this form does not necessarily indicate that you
agree with the disciplinary action.
________________________________________________________ _______________________________
Employee Signature Date
________________________________________________________ _______________________________
Supervisor Signature Date
________________________________________________________ _______________________________
Witness Signature Date
Mississippi Delta Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its
programs and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies: The
Associate VP for Institutional Effectiveness, Boggs-Scroggins Student Services Center, P.O. Box 668, Moorhead, MS 38761, 662-246-
6558.
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Employee Disciplinary Form (Mississippi Delta Community College)

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Completed 19 September 2020

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