Fillable Oral Reprimand Form

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Oral Reprimand Form

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BROWSE CITY (AR) FORMS

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08/05 PE49
CITY OF LITTLE ROCK
COPY: Check One
Department
Employee
NON-UNIFORM EMPLOYEE
DISCIPLINARY ACTION FORM
RECORD OF ORAL REPRIMAND
DATE
EMPLOYEE #
DEPARTMENT
DIVISION
Employee Name
Complete Home Mailing Address
This is to advise you that you are hereby orally reprimanded for the following reasons:
You are hereby warned that a recurrence of this infraction, or other infractions, will result in further disciplinary
action.
Oral reprimands are not subject to appeal.
____________________________/_________ _________________________________ /________
Employee's Signature Date Immediate Supervisor's Signature Date
(Does not necessarily imply agreement with
the stated reasons and/or disciplinary action.)
OR
(if applicable)
/ /
1. Witness Date Division Manager’s Signature Date
/ /
2. Witness Date Department Director’s Signature Date
(indicates review and approval)
/
Union Steward’s Signature Date
(if applicable)
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Oral Reprimand Form

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Completed 21 March 2020

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