Letter Date
*
-
Month
-
Day
Year
Date
Prefix
Name of Employee
*
First Name
Last Name
Position
Department
Name of Employee
*
First Name
Last Name
Date(s) of the incident
Title of the Code of Conduct/Ethics Violated
Explain the Details of the Violation Committed
Number of days of suspension
Suspension pay
Date of Suspension Commence
*
-
Month
-
Day
Year
Date
Number of days of suspension
Date of Return
*
-
Month
-
Day
Year
Date
Signature
*
Clear
Human Resources Manager Name
*
First Name
Last Name
Date Signed
*
-
Month
-
Day
Year
Date
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Employee Signature
*
Clear
Should be Empty: