Extension of Active Disciplinary Action

For the following employee:

Employee Name: *

Employee Title: *

Employee Appointing Authority: *

Employee Department for County Administrator (BCC) only: *

Employee Email: *

Employee Number: *

We appreciate the efforts you have made to improve your performance/behavior; however, the expected performance/behavior has not been met or you have received additional discipline and the below discipline’s inactivation date has been extended. *

Date of discipline: * +

New date for inactivation eligibility: * +

This form was completed by:

Supervisor Name: *

Supervisor Title: *

Supervisor Email: *

Today's Date: * +

It is to your benefit to follow all the County rules and department policies and conduct yourself responsibly.

This form will be submitted to Human Resources to update the employee’s personnel file. The employee and supervisor will automatically receive copies of the completed form via email.

For questions, please call (727) 464-3367, option 2, or email employee.relations@pinellas.gov.