<p> PLAINVIEW-OLD BETHPAGE CENTRAL SCHOOL DISTRICT 106 Washington Avenue, Plainview, New York 11803</p><p>106 Washington Avenue Plainview, NY 11803 (516) 434-3040</p><p>MEMO TO: [Employee Name] FROM: [Name], Building Principal [Supervisor] DATE: XX/XX/XX RE: Incident of [day, date]</p><p>On [date of meeting] , you and I met to discuss an incident occurring on [date of incident] . Your union representative, [name] , was also present. [or, you were offered the right to bring a union representative, but declined].</p><p>On [date of incident] , [I observed you] [you reportedly] [describe incident]______. [I appreciate your honesty in admitting that the incident did occur as described above] [or] [your version of the incident is]. </p><p>Behavior of this type is improper because [explain]. There should be no recurrence. If there is, you may well be subjected to disciplinary sanctions, up to and including discharge, in the manner provided for by law and by the collective bargaining agreement. </p><p>In order to help you to avoid further problems of this nature, I am offering the following suggestions: 1. 2. 3. </p><p>Let me reiterate that the purpose of this memo is to warn you of the serious consequences of any future incident, and to instruct you as to how to avoid such problems in the future. This memo should not be construed as a formal accusation, charge, or formal disciplinary action. Neither is it intended to rule out formal disciplinary action for this incident. A copy of this memo will be placed in your personnel file. If you wish to respond or further clarify the situation in any way, you may submit a written response, which will also be placed in your file. </p><p>Please sign this memo where indicated below. Your signature serves as an acknowledgement that you have had the opportunity to review and respond to the memo, that you received a copy, and that you are aware that a copy will be placed in your file. It does not necessarily indicate your agreement with my opinion. If you have any questions, please feel free to contact me. </p><p>______Employee Signature Date: </p><p>______Print Name</p><p>______Administrator Signature Date: cc: personnel file</p>