 | Original Document: 
Reference Documents:
Text of Document: 
CITY OF DUNLAP PERFORMANCE CORRECTION NOTICE
Employee Name: Department:
Date Presented: Supervisor:
Disciplinary Level
Verbal Correction - (To memorialize the conversation.)
_ Written Warning - (State nature of offense, method of correction,
and action to be taken if offense is repeated.)
Investigatory Leave - (Include length of time and nature of review.)
__ Final Written Warning
Without decision-making leave
_ With decision-making leave (Attach memo of instructions.)
With unpaid suspension
Subject: ______________________________________________________________________
_ Policy/Procedure Violation
_ Performance Transgression
_ Behavior/Conduct Infraction
Absenteeism and Tardiness
Prior Notifications
Level of Discipline Date Subject
Verbal ____ __________________________
Written
Final Written
Incident Description and Supporting Details: Include the following information: Time, Place, Date of Occurrence,
and Persons Present as well as Organizational Impact.
Performance Improvement Plan
1. Measurable/Tangible Improvement Goals:
2. Training or Special Direction to Be Provided:
3. Interim Performance Evaluation Necessary?
4. In addition, I recognize that you may have certain ideas to improve your performance. Therefore, I encourage
you to provide your own Personal Improvement Plan Input and Suggestions:
(Attach additional sheets if needed.)
Outcomes and Consequences
Positive:
Negative:
Scheduled Review Date:
Employee Comments and/or Rebuttal
(Attach additional sheets if needed.)
X
Employee Signature
Employee Acknowledgment
I understand that the City of Dunlap is an “at-will” employer, meaning that my employment has no specified
term and that the employment relationship may be terminated any time at the will of either party on notice
to the other. I also realize that the City of Dunlap is opting to provide me with corrective action measures,
and can terminate such corrective measures at any time, solely at its own discretion, and that the use of
progressive discipline will not change my at-will employment status.
I have received a copy of this notification. It has been discussed with me, and I have been advised to take
time to consider it before I sign it. I have freely chosen to agree to it, and I accept full responsibility for my
actions. By signing this, I commit to follow the city’s standards of performance and conduct.
_____________________ _________________
Employee Signature Date Supervisor’s Signature Date
Witness: (if employee refuses to sign)
Name Date Time in conference
Distribution of copies: Employee Supervisor Department Head Human Resources |