Last Name First M. I. Department
This is an advisory notice. Future violations or failure to improve may result in further disciplinary action up to and
including termination. (Please see back of form for additional information)
Type of Notice: Type of Infraction:
Written Warning
Verbal Warning
Violation of Policies or Procedures
Excessive Tardiness or Absence
Poor Job Performance
Other (describe briefly)
COMPLETE DETAILS OF THIS INFRACTION (Including time and date):
ACTION TO BE TAKEN:
PREVIOUS WARNINGS: Yes No If “YES” complete the following:
Verbal
Written
Day Mo Yr TYPE OF INFRACTION
Employee’s Comments:
Employee signature acknowledges only that this notice has been read and discussed. It does not constitute
agreement with the contents of this notice.
Employee’s Signature/Date Supervisor’s Signature/Date
Human Resource Representative/Date Department Head/Date
Employee Counseling Notice
City of Gulfport
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signature
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signature
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Nothing in this Notice in any way creates or should be construed or read to create any employment contract or
contractual obligation or warranty or promise of or entitlement to employment between or among the employee and
the City or otherwise. Nothing in this Notice changes or alters or should be construed or read in any way to change or
alter the “at will” status of employees, meaning such employees may still be terminated from employment for any
reason or no reason at all, with or without notice, and without resort to any pre- or post-disciplinary processes,
procedures, or administrative hearings. In addition, nothing in this Notice confers or should be construed or read in
any way to confer “Civil Service” status on employees or to afford or provide them with any privileges or expectations
of or entitlement to any protections, rights, or benefits conferred upon or provided to those employees who have
previously acquired “Civil Service” status as set out or further described in Miss. Code Ann. § 21-31-1, et seq. (Rev.
2001) and § 1-68.1 and § 1-68.2 of the City of Gulfport’s Code of Ordinances.
Additional Notes: