RECORD OF DISCIPLINARY ACTION

Date  ____________________________________________

Employee  ________________________________________

Supervisor  _______________________________________

REASON(S) FOR ACTION

 
 
 



PROBATION PERIOD

Date of First Warning (Verbal)
Date of Second Warning (Verbal or Written)
Probationary Period to Begin On
Probationary Period Effective Until

 

GOALS TO BE ACHIEVED DURING PROBATION PERIOD

 
 
 

Violation of probationary period or failure to achieve probationary period goals will result in:

q       Suspension q       Termination

I understand completely the reason(s) for my probation and the goals established for its duration. I understand that if I fail to reach the goals my employer has set for me, or if I violate my probationary period by continued infraction, I will be subject to the action outlined above.

 

__________________________________
Signature of Supervisor

 

 __________________________________
Signature of Employee

 
__________________________________
Date		 __________________________________
Date

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Probationary period successfully completed on   ______________________________________

Employee terminated on   ________________________________________________________

 

__________________________________
Signature of Employee

 

 __________________________________
Signature of Supervisor

 
__________________________________
Date		 __________________________________
Date