Written Notice

Section One

Employee’s Name _______________________________________________________ Agency ___________________________

*Inactive date is the issued date:	plus 2 years for a Group I,	plus 3 years for Group II, or	plus 4 years for Group III.

Offense Date(s) _________________	Issued Date__________________	Inactive Date*____________

Issued by: _____________________________________________________________________________

Print name Title Signature

Section Two - Offense

Type of Offense: Check one and include Offense Category (See Addendum for Written Notice Offense Codes/Categories)

Group I _______________ Group II ______________ Group III _______________

Nature of Offense and Evidence: Briefly describe the offense and give an explanation of the evidence. (Additional documentation may be attached.) Documentation attached? Yes _____ # of pages _____	No _____

___________________________________________________________________________________________________________

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Section Three – Disciplinary action taken in addition to issuing written notice

Suspension from________________ through _______________ Return to Work ________________ #Days Suspended **______

Date	Date	Date/Time

**Note: FLSA exempt employees may be suspended in whole days only.

Transfer or demotion (check below as appropriate)

Reduced Duties with _______% disciplinary pay reduction*** effective ________________

Date

***Note: Salary reduction of at least 5% is required. Also requires HR approval	Disciplinary Transfer – Same Pay Band with _____% disciplinary pay reduction*** effective ____________	Date

Demotion to lower Pay Band with ______% disciplinary pay reduction*** effective _____________

Date

New Role Title ________________New Position #_____________New Location____________________

Termination __________________________

Effective Date

Section Four – Circumstances considered

Describe any circumstances or background information used to mitigate (reduce) or to support the disciplinary action above.

(Additional documentation may be attached.) Documentation attached? Yes _____, # of pages _____	No _____

___________________________________________________________________________________________________________

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Section Five - Notice to employee

It is expected that the situation described above will be corrected immediately in accordance with the Standards of Conduct for employees and/or the performance

measures outlined in your Employee Work Profile. A Written Notice Form may be used in place of a Notice of Improvement Needed Form and may affect your overall performance rating. In the event that this situation is not corrected, or another offense occurs, you may be subject to further disciplinary action, up to and including termination, as outlined in the JMU's Standards of Conduct policy, http://www.jmu.edu/JMUpolicy/1317.shtml. If you wish to appeal this disciplinary action, you may do so under the provisions of the Employee Grievance Procedure within 30 calendar days of your receipt of this Written Notice. For more information about the Grievance Procedure, contact an HR Consultant, (540) 568-6165, or DHRM’s Office of Employment Dispute Resolution at 1-888-232-3842, or http://www.dhrm.virginia.gov/employmentdisputeresolution.html. Non-probationary Campus Police Officers may seek an alternative process to EDR’s Grievance Procedure to address complaints within their department. Campus Police Officers may contact an HR Consultant for assistance with either process.

Section Six – Employee’s signature

Employee Signature________________________________________________________________	Date___________________

Your signature only acknowledges receipt of the notice and notes the date of receipt. Your signature does not imply agreement or disagreement with the notice itself. If you refuse to sign, someone in a supervisory position within the agency will be asked to initial the form indicating that you received a copy of the form and date of receipt.

Employee refused to sign/unavailable to sign	Witness Initials __________	Date _______________

Written Notice Offense Codes

01	Attendance/excessive tardiness
02	Leaving work without permission
03	Failure to report without notice
04	3 days absent without authorization
11	Unsatisfactory Performance
12	Uniform violation/personal grooming
13	Failure to follow instructions and/or policy
14	Safety rule violation
31	Violation of Policy 1.05, Alcohol and Other Drugs
32	Violation of Policy 1.80, Workplace Violence
33	Violation of Policy 2.05, Equal Employment Opportunity
34	Violation of Policy 2.30, Workplace Harassment
35	Abuse of state time
36	Obscene or abusive language
37	Disruptive behavior
38	Conviction of moving traffic violation while using a state vehicle
51	Unauthorized use of State property or records
52	Computer/Internet misuse
53	Failure to report misdemeanor (if required)
54	HIPAA violation
55	Fraternization with patient/inmate/client
56	Insubordination
57	Refusal to work overtime as required
71	Sleeping during work hours
72	Theft
73	Threats or Coercion
74	Falsifying records
75	Gambling
76	Criminal conviction
77	Damaging state property or records
78	Interference with state operations
79	Unlawful weapons possession
81	Patient/inmate/client abuse
99	Other (describe)