Revised 07/31/08
Employee Warning Record
____________________________________
Employee’s Name Supervisor
Warning: The following action will be made part of your official personnel record.
Date and time of violation Date and time action was taken
Reason for action taken:
Unreported Absence Violation of School Policies
Tardiness Violation of Office Policies
Leaving Without Permission Violation of Safety Rules
Ineffective Work Performance Violation of Dress Code
Improper Conduct Other: Explain under “Remarks”
Failure to Comply with Directions
Supervisor’s Remark
Has employee been warned previously? Yes No
Date of Warning Oral or Written
1.
2.
3.
Supervisor’s Signature Date
Employee’s Remarks Regarding Violation
I have been given an opportunity to include remarks concerning the above matter. I certify that this
warning has been discussed with me. I understand my signature does not necessarily indicate agreement.
Employee’s Signature Date
Please fill out information in the spaces provided.
Requires signature.
Deliver completed form to Human Resource
Services.
Requires signature.
Deliver completed form to Human Resource
Services.
