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Sink Pipe

Standard of Excellence

Dismissal Report - Not Eligible for Rehire







This form is to be used as part of the “Standards for Excellence” program. Nothing contained herein shall be used to convert an employment at will relationship into a terminable for cause relationship.

Dismissed Employee Information

Union Affiliation (of Employee)
Plumbers Local 98
Pipefitters Local 636

Employee – By signing below, you acknowledge that the employer has reviewed this form with you and explained the reason for your dismissal. You also acknowledge that you were given the opportunity to provide comments and the comments are factual and accurate in your assertion. This is not an admission of wrongdoing or guilt.

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Contributor Information

Did you inform the Employee that they were being dismissed and not eligible for rehire?
Yes - The employee was informed
No - The employee was not informed
Was the Union informed of this dismissal?
Yes - I contacted the Union
No - I have not contacted the Union
Time of Union Contact
Time
HoursMinutes
Would you like to be contacted as a follow-up to this submission?
Yes- Please contact me
No need for follow-up

By signing below you confirm that the information provided above is accurate. You also acknowledge that you may be contacted by a representative of MCA Detroit, the applicable Local Union, and/or BeneSys if additional information is needed.

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Form will be submitted to: MCA Detroit, Respective Local, BeneSys

​© 2025 Mechanical Contractors Association of Detroit

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