1. Has a verbal warning been given?
2. Type of warning
3. Explain why this warning is being given (Additional information can be provided below).
5. Describe the change in behavior that is expected of the employee:
6. Describe the consequences if this behavior is not changed:
7. Employee statement or rebuttal:
_____________________________________________________________________________________
_____________________________________________________________________________________
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TO BE READ AND SIGNED BY THE EMPLOYEE:
The above problem(s) have been discussed with me, and I understand that failure to improve my performance or additional unsatisfactory behavior will result in further disciplinary action, up to and including suspension or termination. I understand that my signature does not necessarily signify agreement with the facts or actions stated. If I disagree, it is my option and responsibility to pursue an appeal as follows:
Employee's signature: ________________________________ Date: ____________________
-or-
Employee was asked to sign this written warning on _______________ but declined to sign.
Witnessed by: ________________________________________ Date: ____________________
Name:
Title:
Supervisor's signature: _______________________________________ Date: _____________