[Type text] [Type text] Revised: December 2015
Notification of Disciplinary Action
Date: ______________________
Employee Name: __________________________________ I.D. Number: _______________
Last First Middle
Department: ______________________________________ Division: ___________________
Type of Action: [ ] Written Reprimand [ ] Demotion
[ ] Probation [ ] Termination
[ ] Suspension
Reason for Disciplinary Action: ____________________________________________________
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Corrective Action Expected of Affected Employee and Date for Compliance: _______________
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Date for Follow-up Meeting: ______________________________________________________
Comments from Affected Employee: _______________________________________________
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_____________________________________ _______________________________________
Supervisor’s Signature Date Director’s Signature Date
Employee’s signature indicates he/she received Notification of Disciplinary Action and is not
intended to show employee’s agreement with the action taken.
______________________________________ ______________________________________
Employee’s Signature Date City Manager’s Signature Date
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