Letter of Counseling Example for Disrespect

6. UNIT/OFFICE SYMBOL	7. REASON FOR COUNSELING	8. OTHER INFORMATION
	Insubordinate Conduct toward an NCO Violation of Article 91
COUNSELING
9. SUMMARY OF COUNSELING (Give details, facts, specific dates, times, names, sequence of events, etc.)
Investigation has disclosed that you were disrespectful to SSgt Jones, your supervisor, by refusing to follow her direction, saying "kiss my ass" or something similar, and walking away while she was talking to you. This incident occurred around 0700 on 12 July 2014 at the POL main workcenter.
10. RECOMMENDATIONS AND ADVICE OF COUNSELOR
You are hereby counseled. I will not tolerate disrespect from anyone in this organization toward any of their supervisors. Your disrespect and failure to recognize authority has been detrimental to unit morale and the discipline of this organization. You must never again repeat such conduct. If you do, it will be answered with more serious consequences. You will acknowledge receipt of this letter by signing in the designated block. You are advised you have 3 duty days in which to submit any information in rebuttal to these charges. Privacy Act statement: AUTHORITY: 10 U.S.C. 8013. PURPOSE: To obtain any comments you desire to submit (on a voluntary basis) for consideration concerning this action. ROUTINE USES: Provides you an opportunity to submit comments or documents for consideration. If provided, the comments and documents you submit become a part of the action. DISCLOSURE: Your written acknowledgment of receipt and signature are mandatory. Any other comment or document you provide is voluntary. NOTE: This Privacy Act Statement must be included in all Letters of Counseling.

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ACKNOWLEDGMENT OF COUNSELING
14. SUMMARY OF COUNSELEE'S COMMENTS
I acknowledge receipt of this Letter of Counseling on 13 July 14. I do / do not intend to submit information in rebuttal of the facts presented here. I understand I have 3 duty days in which to submit my rebuttal.