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F�= <br />Orange County Children's Therapeutic ARTS Center <br />2215 N Broadway • Santa Ana, CA 92706 • 714.547.5468 • Fox 714.564.9690 • www.occtac.orc0 <br />501(c)3 Federal Tax ID# 33-0930891 <br />Verbal/Written Warning <br />Workforce Investment Act Program <br />A meeting was held with <br />Date of Warning: <br />WIA <br />Representative: <br />Type of warning: <br />❑ Verbal Warning <br />❑ First and final written warning <br />and a formal warning was issued. <br />Time <br />commenced: <br />Time finished: <br />Reasons for the written warning (attach or refer to any relevant notes / documentation): <br />WIA Participant's response was: <br />WIA representative's comments: <br />Agreed action: <br />A copy of this written warning was provided to the WIA participant on _ / / <br />It was explained that future breaches or performance issues may result in further disciplinary action <br />that may include termination of Work Experience Placement and dismissal of WIA program. <br />WIA Representative's Name (Print) <br />Case Manager's Name (Print) Signature <br />WIA Participant Name (Print) Signature <br />