REPLACE WITH DEPARTMENT LETTERHEAD

DATE:

(Date of letter should be same date that the employee receives the letter.)

TO:

Mr./Ms. FULL NAME (FIRST AND LAST) - Include middle/nickname if necessary.

FROM:

SUPERVISORS FULL NAME

DEPARTMENT NAME, CB# XXXX

RE:

Disciplinary Decision of Dismissal

Purpose of Notification
This letter is formal notification of my decision that, effective <DATE>, you are being dismissed from
employment due to your <Unsatisfactory Job Performance, Grossly Inefficient Job Performance,
Unacceptable Personal Conduct> specifically, for < >.
Relevant Past Occurrences or Active Disciplinary Actions
<Note any past conversations with employee regarding this topic, including informal counseling
sessions. If there are any other active disciplinary actions, list them with a brief synopsis. Generally,
you can copy this section directly from what was included in the PDC letter.>
1.

On <DATE> you and I met regarding () and I instructed you to ()

2. On <DATE> you received an Informal Counseling Memo regarding unsatisfactory job

performance, specifically due to ()
3. On <DATE> you received a Written Warning for unacceptable personal conduct,
specifically due to ()
Incidents Resulting in This Disciplinary Decision
<Detail what events occurred, cite relevant policy as needed, ie, provide the specifics of the event, the
employees responsibilities in this event, and how these actions may violate University policy, fail to
meet work expectations, or are otherwise unacceptable. Generally, you can copy this section
directly from what was included in the PDC letter.>
1.

<POINT #1>

2. <POINT #2>
3. <POINT #3>
4. <POINT #4>
Additional Information Provided at Pre-Disciplinary Conference
On <DATE> you attended a pre-disciplinary conference to discuss this issue. Also present at this
Conference were <NAME>, Employee & Management Relations Consultant from the Office of Human
Resources, and myself.
<Describe the course of events of the PDC; what questions were asked of the employee, what responses
were given, what questions the employee asked and responses given. Be specific. Whenever possible,
match the enumerated points from the Incidents Resulting section above.>
1.

<POINT #1>

2. <POINT #2>
3. <POINT #3>
4. ...
Disciplinary Decision
Based on all information provided regarding this issue, <I find the allegations of harassment warranted,
I find that you had sufficient training to complete the assigned tasks appropriately yet failed to do so,
I find that you inappropriately used University resources in violation of University policy, etc.>
Therefore, I have decided to dismiss you from your employment with the University, effective <DATE>.
All applicable payouts of leave or earned time off will be made to you, as provided by University policy,
and any debts you may owe to the University will be deducted in your last paycheck, as required by law or
State policy.
<Also indicate that keys, badges, etc, must be returned to the department at the time of separation.>
Retention of Disciplinary Action and Public Access to Records
This disciplinary action is being issued pursuant to the Universitys Disciplinary Action Policy for SPA
employees and will be retained as part of your permanent personnel file along with all related disciplinary
action documents. Please be aware that North Carolina General Statute 126-23(a)(11) provides that
dismissal letters are public information and must be released if requested.
Appeal Rights
You have the right to appeal this disciplinary action under the University's SPA Grievance Policy. To be
eligible, you must submit your appeal to Employee & Management Relations in the Universitys Office of
Human Resources within 30 calendar days of receiving this disciplinary action. A copy of the Grievance
Policy is attached. For your convenience, you also may obtain a copy of the SPA Grievance Policy through
Employee & Management Relations or at the Office of Human Resources website at http://hr.unc.edu/. If
you have questions about your appeal rights, please contact the Grievance Coordinator in Employee &
Management Relations at (919) 843-3444.
Supervisors Signature
Supervisors Signature:

_____________________

Date:

________________

<NOTE: AN EMPLOYEES SIGNATURE IS NOT REQUIRED BUT IS RECOMMENDED; YOU ARE NOT
REQUIRED TO INCLUDE THE ACKNOWLEDGEMENT LANGUAGE BELOW.>
Employee Acknowledgement
I acknowledge that I have received this disciplinary letter. I understand that my signature below does not
necessarily imply agreement with the disciplinary action taken.
Employees Signature:

_____________________

Date:

________________

Attachment: SPA Grievance Policy

cc: NAME <Chair of the Department/Division>
Deans Office <if required by Deans Office>
Employee & Management Relations, Office of Human Resources (for University Personnel File)
Department Personnel File

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