<p>Employee – Warning Notice</p><p>(Please Print)</p><p>Employee Name ______Date of Warning ______/______/______</p><p>Employee/Payroll # ______Department ______</p><p>Disciplinary Level Type of Violation (Subject) Previous Warnings  Verbal Correction (To  Policy/Procedure Violation  1st Warning memorialize the conversation) Date ______Oral or Written By Whom ______ Written Warning (State nature  Performance  2nd Warning of offense, method of Transgression Date ______correction, and action to be Oral or Written taken if offense is repeated) By Whom ______</p><p> Investigatory Leave (Include  Behavior/Conduct  length of time) Infraction  Final Written Warning  Absenteeism and Tardiness </p><p>EMPLOYER STATEMENT EMPLOYEE STATEMENT  I agree with Employer’s statement. Date of Incident ______/______/______Time ______AM  I disagree with Employer’s description of PM violation for these reasons: ______</p><p>Action to be taken  Warning  Suspension  Dismissal Consequence should incident occur again ______</p><p>I have read this Employee Warning Notice and understand it</p><p>Signature of Employee ______Date ______</p><p>Signature of Supervisor who issued warning ______Date ______This form is an example. It is not a “model” form; it has not been reviewed by attorneys; and it does not necessarily reflect the employment laws in any or all of the fifty states. We urge you to use this as a sample, not a model; adapt it to your own organization’s policies, practices, and culture; and above all, have any new form reviewed by legal counsel. This form is an example. It is not a “model” form; it has not been reviewed by attorneys; and it does not necessarily reflect the employment laws in any or all of the fifty states. We urge you to use this as a sample, not a model; adapt it to your own organization’s policies, practices, and culture; and above all, have any new form reviewed by legal counsel.</p>