COUNSELING MEMORANDUM SAMPLE

James (Jay) E. Girvin, Esq.

20 Corporate Woods Boulevard

Albany, NY 12211

Telephone: 518-462-0300

Facsimile: 518-462-5037



jeg@

COUNSELING MEMORANDUM

SAMPLE

TO:

FROM:

DATE:

RE:

Memorandum of Counseling

1.

The following observation has been made:

?

2.

The following standards will be expected in the future:

?

3.

Set forth why the above was wrong (e.g. violated policy, failure to performance, etc.) and

what the specific expectations are for the future for the employee.

These standards/expectations are important because of the following impact on the school

environment:

?

4.

Set forth facts, incidents, and sufficient detail to describe the concern.

Set forth why the act/failure has a negative impact on the District, co-workers, residents,

morale of colleagues, etc.

Failure to follow the above standards/expectations will result in:

?

5.

e.g. additional counseling, forwarding the next matter to the Supervisor/Board for

consideration of discipline.

The [District] is available to assist you in the following manner:

?

Set forth how you or the District can help, e.g. offer to meet with and explain concerns,

offer list of courses of in-services that might improve the employee's performance, offer to

enter into a professional improvement plan.

Please sign and return this memorandum to _____________ within ______ days. Your signature

acknowledges that you have received a copy of this memorandum. You have the right to submit a written

response to this memorandum which, if submitted, will be attached to the memorandum.

I am forwarding this Memorandum of Counseling to the Supervisor/Clerk for inclusion in your

personnel file.

Sincerely,

I have read and received a copy of this Memorandum.

Employee

cc: Employee's Supervisor

[Other involved Administrators]

Personnel File

Date

James E. Girvin, Esq.

jeg@

COUNSELING MEMORANDUM LETTER

TO BE TYPED ON LETTERHEAD)

(Presented to Staff Member at a Meeting with Representative Present)

COUNSELING MEMORANDUM

TO:

FROM:

DATE:

RE:

INCIDENT OF: ____________

(Date)

On (date of meeting), you and I met to discuss an incident occurring on or about (date of incident).

Your union representative, (name) was also present. (or, you were offered the right to bring a union

representative, but declined).

On (date of incident), (I observed you or, you reportedly) (describe incident-who, what, when, where).

(I appreciate your honesty in admitting that the incident did occur as described above) (or) (your

version of the incident is __________). (State any prior notification, e.g. verbal warnings, memos, etc.

about this incident or any other incidents of a similar nature that may indicate a pattern of behavior)

Behavior of this type is improper because ____________________. (Make reference to Employee

Handbook, Administrative Regulation, District Policy, and Civil Service Law, etc.) There should be no

recurrence. If there is, you may be subjected to disciplinary sanctions, up to and including discharge, in

the manner provided for by law and/or the collective bargaining agreement.

In order to help you to avoid further problems of this nature, I am directing you to:

1.

2. ___________________________________

3. ___________________________________

Let me reiterate that the purpose of this Counseling Memorandum is to warn you of the serious

consequences of any future incident, and to instruct you as to how to avoid such problems in the future.

This Memorandum should not be construed as a formal accusation, charge, or formal disciplinary action

at this time. Formal disciplinary action based on the issue(s) addressed in this Counseling Memorandum

could take place in the future.

A copy of this Counseling Memorandum will be placed in your personnel file. If you wish to respond or

further clarify the situation in any way, you may submit a written response, which will also be placed in

your file as an attachment to this Memorandum.

Please sign this Counseling Memorandum where indicated below. Your signature serves as an

acknowledgment that you have had the opportunity to review the Memorandum, that you received a

copy, and that you are aware that a copy will be placed in your file. It does not necessarily indicate your

agreement with the contents.

If you have any questions, please feel free to contact me.

___________________

Date

_____________________________

Supervisor Administrator

Date

_____________________________

Employee Signature

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download