Complaint Form

Date Occurred

Time Occurred

Location of Occurance

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reporting Party's Name

First Last

Phone

Reporting Party's Sex

Reporting Party's Date of Birth

Reporting Party's Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employees Named

Employee ID#

Employee's Full Name

Rank / Position

Location / Assignment / Vechicle #

Employment Date

Witness

Code

Full Name

Sex

Date of Birth

Address

Phone

Codes: AV = Alleging Misconduct as Victim; NV = Alleging Misconduct as Non-Victim; W = Witness Sex: M = Male; F = Female

Narrative

Submitting your complaint

I understand that this statement of complaint will be submitted to the Vanderburgh County Sheriff’s Office and may be the basis for an investigation. I understand that under the regulations of the Vanderburgh County Sheriff’s Office, the employee(s) against whom this complaint is filed may be entitled to request a hearing before a board of inquiry (Merit Board). Further, I understand that I am not required to sign this complaint, but by filing it, I may be called to testify under oath before a board of inquiry if one is requested by the employee.

Name

First Last

Date

Time

Name

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Complaint Form

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