Disciplinary Action Form
K Street Supervisor:
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First Name
Last Name
Officer on duty:
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First Name
Last Name
Post:
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Date:
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Month
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Day
Year
Date
Time:
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1
2
3
4
5
6
7
8
9
10
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Description:
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Disciplinary Action Taken:
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Type of warning:
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First written warning
Second and final written warning
First and final written warning
Terminated
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K Street Supervisor Signature:
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It was explained that future performance issues may result in further disciplinary action that may include termination of employment. This warning will be placed in your personal file but will be disregarded after 6 months of excellent work performance. Officer signature:
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