87 Washington Street, Rensselaer, New York, 12144, T : 518-449-1142

EMPLOYEE COUNSELING FORM

Employee Name:  
Date:
Coordinator:
Reason for Discipline:  
Disciplinary Action:  
By means of: In Person   Skype    Phone    
Description of Issue(s):  
Issue Resolution and Expected Results:  
is aware that this is their final warning. Any subsequent issues/violations of policy may result in immediate termination.
Employee Name PRINT:
Employee signature:

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 		 Date:
Witness Name PRINT:
Witness signature:

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 		 Date:
Supervisor name PRINT:
Supervisor signature:

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 		 Date:
      


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