Purpose of meal or trip: ___ Companies or individuals visited: ____ *List Persons entertained, nature of entertainment and results of the meeting: ________ ________

Location Odometer Miles Gallons Cost MPG Date                                                                                   &am

1. Statement of the problem which may include violation of rules, policies, standards, practices, or unsatisfactory performance: ___ ________ ________. 2. Documentation of prior discussion or warnings on this subject: (oral, written, dates) ________ ...

Results were excellent and continually exceeded requirements in most areas. Results at times exceeded requirements in most areas. Results met most requirements, but were marginal in some areas.

What was your previous address? How long at present address? Please fill out and return to the Personnel Department.

TOTAL TRANSPORTATION   Sun. Mon. Tues. Wed. Thurs. Fri. Sat. Air Fare:               Car Rental               Transportation               Parking/Tolls               Mileage           &nbsp

Describe the strengths of this employee: ______ ______ ______. Please provide specific examples of the major achievements of this employee during the review period: _____ ______ ...

The following definitions apply to each factor rated below: Level 4 - Meets and usually exceeds job requirements Initiative Level 1 2 3 4 5 6 Job Cooperation Level 1 2 3 4 5 6

Car Postg Cop- ies Misc. Trvl. Totl.     $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00     $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00     $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00     $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00     $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00     $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00     $0.00 $0.00 $0.00 $0.

DAILY CASH RECEIPTS RECORD Date Cash Checks Charge Total _ $0.00 $0.00 $0.00 $0.00 Grand Totals $0.00 $0.00 $0.00 $0.00

We met to discuss your unsatisfactory performance on ___ (month & day), __ (year), at ___. In order to improve your level of performance as per our discussion, we agreed that you should: _______. However, unless these matters can be corrected, I shall have no alternative but to instigate further disciplinary or corrective action, which may include but is not limited to suspension.

Location Odometer Miles Gallons Cost Mpg Date                                                                                   &am

REIMBURSEMENT OF EXPENSES Date Required: ____ Time Needed: ____ Amount of the Check: $___

[ ] New Hire [ ] Voluntary Resignation [ ] Promotion [ ] Leave of Absence Comments and reasons for change: ____ ________ ________ _______. Original to Department Manager, copy to Personnel File.

Effective _ (month & day), ___ (year), we regret to inform you that your employment with the Company is terminated for cause, due to the following reason(s): ________ ________ . As of the above date, you are required to vacate the premises. Please take all personal possessions with you upon your departure.

PHONE RECORD List all personal calls (including local) and all long distance business calls including (Name of City) area codes and number. Area Code & Number Contact Name & Company Reason for Calling

State your grievance in detail, including the date of act(s) or omissions causing grievance. Identify other employees with personal knowledge of your grievance. Grievance Team Member - Informal Review Date Received: __ ______.

Employee Name: (previous name if change) _____ Note: An employee is not obligated to report spouses to his or her employer, but the employee may wish to report marital status so the employer can adjust the tax withholding amount. Please fill out and return to the Personnel Department.

DEC 1                         2                         3                         4                 &

Date Where Entertained Who was Entertained and from what Company Business Reason Amount Entertainment expense total on this page must equal the entertainment expense total on Expense Report. Attach all receipts for expenses over $25.00.