ࡱ> QSP ]9bjbj :D< :::::NNN84N(VVVVV1Hy,$ !9:11::VVF:V:VV{Fo0("-"":" A(" : State of Maine Record of Employee Discipline Employee NameEmployee Number FORMTEXT       FORMTEXT      Job ClassificationDate FORMTEXT       FORMTEXT      DepartmentWork Location FORMTEXT       FORMTEXT      NATURE OF DEFICIENCY  FORMTEXT       STEPS NEEDED FOR IMPROVEMENT  FORMTEXT       LEVEL OF DISCIPLINE  FORMCHECKBOX  Written Warning (MSEA & MSLEA)  FORMCHECKBOX  Written Reprimand  FORMCHECKBOX  Suspension -OR-  FORMCHECKBOX  Written in Lieu of Suspension  FORMCHECKBOX  Demotion  FORMCHECKBOX  Dismissal SUPERVISORS SIGNATURESignatureDate Employees Remarks - Please check one of the boxes below and add any further clarifying comments.  FORMCHECKBOX  I agree with the statements above  FORMCHECKBOX  I disagree with the statements above. Indicate areas of disagreement below. ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ Employees Signature - Please read the statement below and sign.I have read and understand the nature of this discipline and further understand that if this deficiency persists, it may result in further disciplinary action up to and including dismissal.Employees SignatureXZ\ 4 6 D F H \ ^ l p ٿմ٦ٿ՛ٿՐٿ}ٿr٦ٿjth'UjhD)UhD)CJaJjhD)Uj2hD)UjhD)UmHnHuj*h'UhD)hD)CJaJjhD)UhD)jhD)UhfMCJaJh Sh SCJ aJ h S5CJ \aJ (Z\x}tkd$$Ifl0J*R 04 laytD)$Ifgd S  $Iftkd$$Ifl0J*R 04 laytD)  F n $Iftkd$$Ifl0J*R 04 laytD)n p $Ifgd'tkd$$Ifl0J*R 04 layt1_ $IftkdP$$Ifl0J*R 04 layt1_ $$Ifa$tkd$$Ifl0J*R 04 layt1_ " $ L N $$Ifa$nkd$$Ifl*+  04 lap  " $ & : < > H J N    * 6 8 : < F H ޺zrjbzbzjh#XCJaJh8CJaJhjSCJaJhyCJaJjc hjhD):U hD):jhD):Uh'MIhfM5CJ\aJh85CJ\aJj h7YUjh7YUmHnHuj+h7YUh7Yjh7YUhD)5CJ\aJhfM5CJ\aJ#N P )nkd9 $$Ifl*+  04 lap  $$Ifa$^kd$$Ifl*+04 la $$Ifa$^kdN $$Ifl*+04 la $$Ifa$ J L " # ? @ ] ^ $$Ifa$gdynkd $$Ifl*+  04 lap  H J L N P l n p r    ! " # $ % ⻳qlea]RHjhy:Uh'MIhyCJaJhyh8 hyhy hy:j hjh8:Uh'MIh8CJaJjS hjh8:U h8:jh8:Uh8CJaJhyCJaJh#XCJaJj hjhD):U hD):jhD):Uh'MIhQmCJaJh'MIhD)CJaJhfMCJaJ% 3 4 5 6 > ? @ A B P Q R S \ ] ^ w " # 1 ·͜{ql\qqlj[hjhD):U hD):jhD):Uh S5CJ\aJhfMCJaJh'MIhy5CJ\aJhy5CJ\aJj hD)hy:UhfM5CJ\aJhyhyCJaJhyCJaJh'MIhyCJaJjhy:UjC hjhy:U hy:^ _ v w nkd$$Ifl*+  04 lap $ $Ifa$^kd#$$Ifl*+04 law {qkd8$$Ifl0J*R 04 la$ $Ifa$ qrmmmmmmm$ $Ifa$$ $Ifa$nkd$$Ifl*+  04 lap  1 2 3 -[e88888888'8(8C8L8M888888888899%929:9;9<9=9?9@9B9C9E9F9H9J9漬ӡޙޑh ShjhUhNCJaJh85CJ\aJjhjhD):U hD):h SCJaJUh8CJaJhfM5CJ\aJhfMCJaJjhD):UjhjhD):U3,- nkd$$Ifl*+  04 lap $ $Ifa$^kdK$$Ifl*+04 la-8'8(8=8>8C8yiYiyy$ $Ifa$gd S$ .$Ifa$gd S$ $Ifa$^kd`$$Ifl*+04 la$ $Ifa$gd8  FORMCHECKBOX  I refuse to sign. Initial: __________ DateWitnesss Signature - Please read the statement below and sign.The above discipline has been explained to this employee and he/she understands its seriousness.Supervisory Witnesss Signature DateEmployee Rep Signature (if present)Date      PER 121 01/17 C8D88{$ $Ifa$qkdL$$Ifl0J*R 04 la8888|^kdo$$Ifl*+04 la$ $Ifa$gd8nkd$$Ifl*+  04 lap 899 999398999:9{qkd$$Ifl0J*R 04 la$ $Ifa$ :9;9<9>9?9A9B9D9E9G9H9Z9[9\9]9 !0*gdCOqkde$$Ifl0J*R 04 laJ9T9U9V9W9X9Y9[9\9]9hfMCJaJhh S hjS5\ h#X5\ hy5\ h S5\ 8P:p S/ =!"#8$8% Dp$$If!vh#v#vR :V l055R / 4ytD)D:Text1Name of EmployeeD Text2-Enter date of request (use format MM-DD-YYYY)$$If!vh#v#vR :V l055R / / 4ytD)$$If!vh#v#vR :V l055R / 4ytD)D2Text3CURRENT Classification/TitleD Text2-Enter date of request (use format MM-DD-YYYY)$$If!vh#v#vR :V l055R / / 4yt1_$$If!vh#v#vR :V l055R / 4yt1_D2CURRENT DepartmentDCURRENT Department$$If!vh#v#vR :V l055R / 4yt1_$$If!vh#v+:V l  05+4p DText7 Home Address$$If!vh#v+:V l05+/ 4$$If!vh#v+:V l  05+4p D Home Address$$If!vh#v+:V l05+/ 4$$If!vh#v+:V l  05+4p xDeCheck229xDeCheck229xDeCheck229xDeCheck229xDeCheck229hDe$$If!vh#v+:V l05+/ 4$$If!vh#v+:V l  05+4p $$If!vh#v#vR :V l055R 4$$If!vh#v+:V l  05+/ 4p xDeCheck229xDeCheck229$$If!vh#v+:V l05+/ 4$$If!vh#v+:V l  05+4p r$$If!vh#v+:V l05+4xDeCheck229$$If!vh#v#vR :V l055R 4$$If!vh#v+:V l  05+/ 4p r$$If!vh#v+:V l05+4$$If!vh#v#vR :V l055R 4$$If!vh#v#vR :V l055R 4^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List 4@4 Header  !4 @4 Footer  !PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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