Calvin College Counseling & Guidance Report
Name of Employee:
Date:
1)
Statement of the situation that occurred and the problem it created:
2)
Action to be taken to resolve the problem:
Disciplinary action to be taken:
Verbal Counseling
Written Warning
Suspension for _______ days
With Pay
Without Pay
Probation for _______ days
Dismissal
___________________________________
Supervisor Signature
________________________________
Date
I have received and read this notice and have been given an opportunity to respond in writing. I have
been informed that a copy of this notice will be placed in my file. My signature does not necessarily
indicate my agreement with the facts presented. However, I understand that continued failure to meet
the established standards of performance and/or behavior may result in further disciplinary action up
to and including dismissal.
___________________________________
Employee Signature
________________________________
Date
Calvin College Counseling & Guidance Report
New
2/14/2017
CT
Title
Revision
Date
Approved