Employment Disciplinary Notice

Employee

Department

_____ Written Warning _____ Final Warning

1. Statement of the problem

2. Prior discussion or warnings on this subject, whether oral or written

3. Company policy on this subject

4. Summary of corrective action to be taken by the Company and/or employee

5. Consequences of failure to improve performance or correct behavior

6. Employee Statement

Employee Signature: ___________________________________ Date _____________

Management Approval: __________________________________ Date _____________

Distribution: One copy to Employee, one copy to Supervisor and original to Personnel File.