ELECTRONIC NOTIFICATION FORM

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Check One*

Termination Notice

Warning Notice

Employee Classification*

Journeyman

Apprentice

CW

CE

Name*

First Last

Employee's Email*

Date*

MM slash DD slash YYYY

Employee Termination or Warning for Reasons Checked Below:*

Reduction in Force

Voluntary Quit-Work Available

Not for Rehire

Harassment of Co-Workers

Horseplay

Non-Compliance with Company/Customer Work Rules

Violation of Safety Policies

Misuse of Employer's Tools

Unprofessional Attitude/Appearance

Under the Influence of Drugs or Alcohol

Absenteeism

Theft

Jobsite Violence

Poor Workmanship/Productivity

Instigation/Participation in Work Slowdown or Stoppage

Other

If Other, Please Explain

Company

By:*

Title

Employer's Email*

Job Site*

Witness*