Fillable Citizen Complaint Procedure Complaint Form (Page 2 of 2) in pdf

Citizen Complaint Procedure Complaint Form Page 2

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Complaint Form

Personal

Your Name:

(Contact numbers) Home:

Cell:

Work:

Zip:

E-Mail:

Street Address:

City:

Officer(s) Involved

Officer 1 Name:

Sex:

Officer 2 Name:

Sex:

Badge#:

Badge #:

Incident Information

Day: _______________ Date: _________________ Time: _________Location: _____________________________________________________

Was anyone else present?

(Provide names, addresses and phone numbers below.)

Yes No

Please describe what happened (attach as many additional sheets as necessary):

__________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Do you believe this incident was an act of profiling?

Yes

If so, please mark one or all that apply below:

Race or Ethnicity

Nationality

Gender

Age

Religion

Gender Identity or Expression

Sexual Orientation

Mental Disability

Physical Disablity

YOU HAVE THE RIGHT TO MAKE A COMPLAINT AGAINST A POLICE OFFICER FOR ANY IMPROPER POLICE CONDUCT. CALIFORNIA LAW REQUIRES THIS AGENCY TO HAVE A PROCEDURE TO

INVESTIGATE CITIZENS' COMPLAINTS. YOU HAVE A RIGHT TO A WRITTEN DESCRIPTION OF THIS PROCEDURE. THIS AGENCY MAY FIND AFTER INVESTIGATION THAT THERE IS NOT ENOUGH

EVIDENCE TO WARRANT ACTION ON YOUR COMPLAINT. EVEN IF THAT IS THE CASE, YOU HAVE THE RIGHT TO MAKE THE COMPLAINT AND HAVE IT INVESTIGATED IF YOU BELIEVE AN OFFICER

BEHAVED IMPROPERLY. CITIZEN COMPLAINTS AND ANY REPORTS OR FINDINGS RELATED TO COMPLAINTS MUST BE RETAINED BY THIS AGENCY FOR AT LEAST FIVE YEARS.

IT IS AGAINST THE

LAW TO MAKE A COMPLAINT THAT YOU KNOW TO BE FALSE. IF YOU MAKE A COMPLAINT AGAINST AN OFFICER KNOWING THAT IT IS FALSE, YOU CAN BE PROSECUTED ON A MISDEMEANOR

148.6 (b) P.C.

CHARGE.

I have read and understood the above statement.

Signature: __________________________________________

Date: _________________________________