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Em ployee W ritten W arning-
EMPLOYEE INFORMATION
Name: Years of Service: Date:
Location: Supervisor:
Description of Infraction:
Plan for Improvem ent:
Consequences of Further Infractions:
Acknowledgement of Receipt of W arning - By signing this form, you confirm that you understand the
inform ation in this warning. You also confirm that you and your supervisor have discussed the warning
and a plan for im provement. Signing this form does not necessarily indicate that you agree w ith this
warning.
Em ployee Signature: Date:
Supervisor Signature: Date:
W itness Signature (if em ployee refuses to sign) Date: