CITY ADMINISTRATORS OFFICE

Name of employee
Position of Employee
Contact Details of Employee

Subject: NOTICE TO EXPLAIN WITH NOTICE OF PREVENTIVE SUSPENSION

Dear Mr./Ms._____________

Please submit your written explanation to the DISCIPLINARY MATTER(S) being charge
against you described or narrated below within FIVE (5) DAYS from the date that this
Notice was served upon you.

Also, please attend the conference to be held on _____, 2018 at _____ at ________ as
this will give you additional opportunity to verbally explain your side and present your
witness and other evidence regarding the said disciplinary matter(s).

You have the right to be represented by any counsel or person of your choice.

In the event that you are found guilty of the said charge(s), the City may terminate you
from employment and/or impose other appropriate penalties.

Furthermore, you have been placed under a 60-DAY PREVENTIVE SUSPENSION

starting on _____, 2018. Unless earlier lifted, your preventive suspension will end on
_________, 2018. Note that preventive suspension is NOT A PENALTY. The City
resorted to preventive suspension because of imminent and serious threat to the
_______ as may be reasonably inferred from the nature of the charge(s) against you.

This Notice consists of ___ pages, plus attachments.

Kindly give this matter your priority attention.

Respectfully,

CFC
DISCIPLINARY MATTER(S):

What was/were the offense(s) committed:

Name of offense
Article
Section
Personnel policies

When was/were the offense(s) committed (date&time):

Date and time

Where was/were the offense(s) committed:

Who is/are being charged of the offense:

Who is/are the witness(es):

How was/were the offense(s) committed:

How much was involved (if any):

How did the offense adversely affect the company:

 ACKNOWLEDGMENT RECEIPT OF NOTICE

Signature Over Printed Name:

Date:
Time:

WITNESS TO THE SERVICE OF NOTICE:

Signature Over Printed Name:
Date:
Time:

Instructions to the Notice Server:

1. Give 1 copy of the Notice to the subject employee.
2. Request him/her to completely fill-up and sign the ACKNOWLEDGMENT RECEIPT OF
NOTICE on City’s copy of the Notice.
3. Fill-up and sign the WITNESS TO THE SERVICE OF NOTICE on the City’s copy, placing
YOUR OWN NAME AND SIGNATURE.
4. However, if the employee refuses to sign, don’t insist or argue. Just leave a copy of the
Notice on his/her cubicle, table or Desk.

a. Then fill-up and sign the ACKNOWLEDGMENT RECEIPT OF NOTICE of company’s

copy, placing YOUR OWN NAME and SIGNATURE with a note: “EMPLOYEE
REFUSED TO RECEIVED”
b. And if there are OTHER witnesses request one of them to sign as witness on the
WITNESS TO THE SERVICE OF NOTICE.

5. Return the city’s copy to HRDO for safekeeping.

6. If the Notice cannot be delivered PERSONALLY to the subject employees, then you must
send it to him/her by way of registered mail (with return card) using his/her las known
address.