Fillable Employee Disciplinary Form (Mississippi Delta Community College)

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Employee Disciplinary Form (Mississippi Delta Community College)

On average this form takes 8 minutes to complete

The Employee Disciplinary Form (Mississippi Delta Community College) form is 2 pages long and contains:

  • 3 signatures
  • 14 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Mississippi Delta Community College

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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 age, race, color, national origin, religion, sex, sexual
orientation, gender identity or expression, physical or mental disability, pregnancy, or veteran status in its educational programs and
activities or in its employment practices. The following person has been designated to handle inquiries regarding the non-
discrimination policies: Steven J. Jones, Vice President of Administrative Services, Tanner Hall, Suite 202, P. O. Box 668, Moorhead,
MS 38761, 662-246-6304; EEOC@msdelta.edu.
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Employee Disciplinary Form (Mississippi Delta Community College)

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Completed 3 February 2021

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