Date:

Employee:

Employee No:

Date of warning:

Shift:

Time: ______ Am/Pm

Violation:

Tick:

[ ] Intoxication or drugs

[ ] Disobedient [ ] Clocking out ahead of time

[ ] Wrongful Conduct

[ ] Tardiness

[ ] Clocking out wrong time card

[ ] Carelessness Absenteeism

[ ] Substandard Work

Other:

Action Taken:

Additional Remarks:

Employee Comments:

This is your second warning of a company rules violation or unsatisfactory performance. Future violations may lead to immediate dismissal without further notice.

Signatures:

____________________ ___________________ __________________

Employee Supervisor Personnel Manager