NOTICE OF EXPLAIN

Form No.:

DATE :
TO :
POSITION :
DEPARTMENT/BRANCH :

This is to inform you that the following offense was allegedly committed by you, as specified below:

Alleged Infraction/Offense:______________________________________________________________________________________
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Date/Time when offense was allegedly committed:__________________________________________________________________

Place where alleged infraction was committed:_____________________________________________________________________

Chronological Sequence of Events (Briefly describe how the offense was allegedly committed)
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(Note: In case the space provided above is not enough, kindly use another paper)

Please explain not later than 48 hours from your receipt of this notice why no disciplinary action shall be taken against you as a
result of the above-stated alleged infraction. Please be advised that the above-mentioned violations carry a corresponding penalty of
_____________________________. Failure on your part to submit a written explanation within the given period shall be deemed as
a waiver of your right to opportunity to be heard and shall constrain us to decide on the case based on the evidence we have at
hand.

Furthermore, considering the nature and gravity of the offense charged and the sensitivity of the nature of the work you are
currently occupying which is a position of trust and confidence that gives you access to confidential files and documents that will be
involved in the investigation, you are hereby placed under PREVENTIVE SUSPENSION effective immediately and for a period of
___________ (____) days while this matter is being investigated.

Signed:

____________________________
Signature of Immediate Superior

Received by:
______________________________
Employee signature over printed name
Date Received:_______________________
Form No.:
EMPLOYEE’S WRITTEN EXPLANATION

Date:___________________________

TO :_____________________________
POSITION :_____________________________
DEPARTMENT/BRANCH :_____________________________
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(Note: In case the space provided above is not enough, kindly use another paper)

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Employee’s Printed Name & Signature

NOTE: Please SUBMIT this form within 48 hours from receipt of Notice of Infraction. Otherwise, your failure shall be deemed as a
waiver of your right to opportunity to be heard and shall constrain us to decide on the case based on the evidence we have at hand.