Employee Name
Today's Date
Position
Hire Date
Department/School
Supervisor Name
This is a:
Written Warning
with Probation - Probationary Period ____________ days.
Administrative Leave** - Dates of leave _________ to _________ .
Suspension** - Dates of leave _________ to _________ .
Termination**
** Must be discussed with Human Resources prior to notifying employee.
Reason for Corrective Action
(Please check box, describe circumstances and
expectations, and attach documentation if appropriate)
Absenteeism/Lateness
Insubordination (Behavioral infraction)
Violation of Policy
Unsatisfactory performance
Failure to follow a procedure
Other (Please specify)
Describe cirumstances and the negative effects on the department or University:
Expectations: State specific performance changes and time period for improvement.
Expected performance changes
CORRECTIVE ACTION NOTICE
Time Period
The reason for this notice was explained to me. My signature acknowledges receipt of the notice.
It does now imply agreemetn or disagreement with the notice itself.
Employee Signature
Date
Supervisor Signature
Date
Witness Signature
Date
(Needed only if employee refused to sign and/or accept notice)
Human Resources Signature
Date
Copies to Employee, Supervisor File, Human Resources