Fill and Sign the Written Warningdischarge Notice Form

Written Warning/Discharge Notice Employee’s Name       Date       Department       SS#       Date of Incident       Date of Hire       Verbal Written Warning Suspension #       Working Day(s) From       Through       Discharge Effective       Reason for warning of discipline. (Check one or more box as appropriate. Explain fully in Remarks Section.) 1. Violation of or failure to observe: a. Work rules b. Work procedures 2. Insubordination 3. Tardiness, absenteeism, failure to report for work 4. Under the influence of and/or possession of drugs or alcohol 5. Dishonesty 6. Failure to observe proper safety procedures 7. Failure to complete work assignment 8. Discourtesy or verbal abuse of guest or other employee 9. Damage or misuse of college property 10 .Unauthorized removal from college premises of department or other property 11. Physical or verbal assault and/or fighting 12. Other (specify in remarks section) Remarks: Explain reasons for warning or discipline, including specific details of incident or violation; include prior warning(s).                                     I hereby acknowledge receipt of a copy of this discipline form. cc: Human Resources       Personnel File of Employee (Printed Name of Employee) (Date) Employee       (Signature of Employee) (Printed Name of Supervisor)       (Signature of Supervisor) Written Warning/Discharge Notice Page 1 of 1