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MIAMI-DADE COUNTY

DISCIPLINARY ACTION REPORT
Employee Name:
Classification:

Department

Date of DAR:
Date of Hire:

Division

Employee Status:
Permanent

Area

ID#

Probational

Other

You are hereby charged with violating the County’s Personnel Rules, Chapter VIII, Section 7: Paragraph:

(Attach additional sheets as necessary)
FACTS: (Description of specific actions, statements made by employee; attach statements of witness, if any, and attach copies of other
documents if appropriate. Also state reasons for recommendation).

(Attach additional sheets as necessary)
_____________________________________________________
Supervisor’s Signature
Date
In signing this Report I acknowledge only that it has been discussed with me and that I have received a copy. I understand that I may
respond orally or in writing and that such response will be made a part of this Report and taken into consideration prior to a final
determination being made.
_________________