Employee Discipline Notice
Employee name: Date:
Position: Department:
Description of problem requiring improvement or correction (include specific dates & examples):
Specific changes in performance or behavior required and the time frame in hich they must occur:
Date of follo!up revie"evaluation of problem and correction :
Failure of employee to correct problem may result in further disciplinary action up to and including
termination of employment.
Employee comments:
Employee signature: Date:
Document if employee declines to comment or sign, and obtain a witness signature in the presence of you and
the employee. (A witness is preferably the person responsible for HR or your supervisor.)
Supervisor comments:
Supervisor signature: Date:
#itness signature: Date:
Employee Termination Exit Checklist
Employee name: Position:
Date of hire: Date of termination:
$opics to discuss:
%%%% Salary"Payroll
Salary through last day of employment
&ccrued' unused vacation through last day
(ther ad)ustments
(commission' travel expenses' etc*)
Disclose any benefits included as taxable ages
$otal of final paychec+:
%%%% Employee benefits:
,ealth -nsurance:
%%%% .(/0& information given to employee
Date coverage ends:
0eimbursement due employee for premium:
%%%% -nsurance company notified
1ife -nsurance:
Date coverage ends:
%%%% -nsurance company notified
234(+) Plan:
%%%% #ithdraal"0ollover information given to employee
Profit Sharing Plan:
%%%% Employee notified of any distribution
0eturn of .ompany Property:
%%%% -dentification badge
%%%% 5eys and +ey cards
%%%% Equipment (1aptop P.' pager' cell phone' tools' etc*)
%%%% .redit cards
%%%% /oo+s and other printed material
%%%% (ther items' list:
$he terminating employee6s forarding address:
.ompleted by:
7ame: Position:
Date:
Employee Exit Interview
Employee name: Position:
Date of hire: Date of termination:
1. #hy are you leaving8
2. -f you are going to another )ob' hat does that )ob offer that your )ob here did
not8
3. #hat factors contributed to your accepting a )ob here8 #ere your
expectations reali9ed8
4. ,o ould you evaluate your salary in comparison to the or+ that you
performed8
5. #hat are some of the factors that helped to ma+e your employment here
en)oyable8
6. #hat comments or suggestions do you have in regard to ma+ing this a
better place to or+8
7. #ould you recommend our organi9ation to a friend as a place to or+8 -f
yes' hy8 -f no' hy not8
(ther comments:
-ntervieer6s signature: Date:
Employee6s signature: Date:
Telephone Reference Check
(State your name' position' and employer*) - ould li+e
to verify some information given to us by (applicant
name ) ho is applying for a position ith our
organi9ation* - encourage you to refer to (applicants)
ritten personnel record to find the information - ill
request* #ould it be convenient for me to call you again
in a fe minutes' or ould you li+e to call me bac+ hen you are prepared8 -f
you ant to call me' hen may - expect your call8
1. #hat ere the dates of (applicants) employment ith you8
:rom %%%%%%%%%%%%%%%%%%%%%%%to %%%%%%%%%%%%%%%%%%%%%%%%%%
(monthdayyear) (monthdayyear)
;* #hat positions(s) did he"she hold hile or+ing for you8 :or
each position' hat as the nature of the or+8
Position: 7ature of or+:
Position: 7ature of #or+:
<* /ased on performance evaluations and other records in
(applicant6s) personnel file' could you please provide me ith facts on the
folloing areas*
&ttendance:
=uality of or+ " productivity:
&bility to ta+e on responsibility and or+ independently:
.onsistency in meeting deadlines and or+ing under pressure:
2* -s there anything else - should +no8
