University of Houston-Victoria
Notice of Dismissal From Employment (Example)
FORM D
| To: | Employee Name, SSN | |
| From: | Name of Department Head or Designee, Job Title | |
| Date: | ||
| Subject: | Notice of Dismissal from Employment |
| Summarize the purpose of the memorandum and state the effective date and time of dismissal. If notice is mailed to the employee, letter should be sent certified, returned receipt requested. |
This is official notice that you are dismissed from employment
effective at (time) on (date).
| State the reason for the dismissal, specifying dates and actions. However, do not provide unnecessary detail. |
You are being dismissed for the following reason:
You have been late for work on seventeen (17) occasions over a 3-month
period. You have continued to report to work from ten (10) to forty-five (45)
minutes late on numerous occasions, despite attempts to correct this behavior
through oral counseling, written reprimand, and suspension without pay. You have
failed to notify the department on occasions when you knew you would be
reporting to work late, and you have failed to provide any compelling reasons
for your continued lateness. This behavior is contrary to departmental policy
and has created work delays and morale problems within your work group.
| Remind the employee of the responsibility to complete the university clearance procedures and return all university property. |
On or before your last day of employment, you must complete the university clearance process and return any university property in your possession. This process begins in the Human Resources Department, and a HR representative will also advise you about your options to continue insurance coverage and apply for refund to your retirement fund contributions.
RECEIVED:______________________________DATE:_________________________