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Personnel Complaint Form

2. Please relate your complaint, include names, times, locations, witnesses, and any other factual supporting information. For complaints involving Racial or Identity profiling please indicate specific alleged profiling <strong>(specific race, ethnicity, nationality, age, religion, gender, gender expression, sexual orientation, mental disability or physical disability)</strong>.

   Please relate your complaint, include names, times, locations, witnesses, and any other factual supporting information. For complaints involving Racial or Identity profiling please indicate specific alleged profiling (specific race, ethnicity, nationality, age, religion, gender, gender expression, sexual orientation, mental disability or physical disability).

4. First Name*

5. Last Name*

7. Phone

8. Email*

10. Address

12. City

13. State

14. Zip

16. Today's Date*
    Today's Date

20. Date & Time of Occurrence
    Date & Time of Occurrence

    Date & Time of Occurrence

22. Location of Occurrence

24. Names & ID Numbers of Officers or Employees Involved*

    If known, please provide this information.

26. Details of Occurrence*

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field