[Date]

Dept: 

Supervisor Name: 

Re: 

Dear [Employee Name] ,
 
Your HR department has been informed by several team members, to include your manager that you have committed the following actions which do not comply with [Company Name] policies: 

As explained in our meeting on [Date] we are documenting this warning and notifying you that effective today, we expect you to comply with job and organizational expectations.  
 
Our goal is to assist you in understanding that a behavior problem or opportunity to improve exists. We expect that you take this opportunity to correct your job performance. 

We are determined to continue enlisting your expert knowledge as an internal support within the organization, and we will do whatever we can to help you improve your performance to meet the organization's quality standards.
 

Retaliation 

Supervisor signature: ___________________Date: _________

Employee Acknowledgement: I hereby acknowledge that I have committed the above infractions and am able and willing to make the required corrections to continue my employment with the [Company Name]. I also understand that the organization has discretion to implement the necessary disciplinary steps including up to termination if deemed warranted.

 Employee signature: ____________________ Date: _________