Fill and Sign the Disciplinary Action Form 497334834

Verbal Warning 1 st Notice 2 nd Notice Suspension Discharge Disciplinary Action Form I Date:       Employee Name:       Employee ID Number:       Department:       Position:       Nature of Violation: Based on the seriousness of the offense indicated below, any of the following could result in immediate suspension. All discharges must be reviewed by affected manager with corporate personnel before becoming final. Refusing work assigned Insubordination Not following work schedule Inappropriate dress for job Violation of time card procedures Failure to assist customers Violation of lunch or break periods Disregard of company policies Misuse or abuse of company property Sleeping on the job Excessive absenteeism Theft of any kind Leaving work without approval Drugs or alcohol on company premises Not following safety procedures Other: ___________________ Not wearing name badge Details of Incident: (Briefly describe what happened below) Date:       Time:       Place:       People Involved:       What Occurred:             Employee’s Comments:             _____________________________________ _______ Department Manager Signature Date _____________________________________ _______ Employee Signature Date ____________________________________ _______ Witness Signature Date