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-- Instrucons: If you wish to commend one (City of Kingston)

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  • 8 check-boxes
  • 53 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Kingston

BROWSE CITY OF KINGSTON (NY) FORMS

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Instrucons: If you wish to commend one of our employees or le a complaint, please complete this form. If compleng by
hand, please write legibly. No personal informaon will be disclosed to the public unless required by law. You can submit
the completed form in person to any member at our headquarters or any sub-staon, mail it to the aenon of the Internal
Aairs Unit at the above address or e-mail it to sheri@co.ulster.ny.us.
I wish to le a (check one):
Commendaon
Complaint
If you are ling a complaint, please indicate the type of complaint you are ling (check one):
Formal Complaint: I want my complaint formally/ocially invesgated, as I feel it pertains to an allegaon of
misconduct and if sustained, may warrant disciplinary acon.
Informal Complaint: I want my complaint/concern recorded, however I understand it will be for informaonal purposes
and may not result in disciplinary acon. If this pertains to a policy or pracce of this agency, I understand that policy or
pracce will be reviewed for possible revision.
Last Name: First Name: Middle Inial: Date of Birth:
Street Address: City: State: Zip Code:
Best Phone Number to Contact: E-mail:
Informaon about you:
Are you compleng this form for someone else?
Yes
No
If yes, please complete the secon below
Their Last Name: Their First Name: Their Middle Inial: Their Date of Birth or Age:
Their Street Address: Their City: Their State: Their Zip Code:
Their Best Phone Number to Contact: Their E-mail:
Why Could/Did They Not Complete This
Form Themselves?
Narrave of Event: Please tell us about why you are subming this document. Aach addional sheets of paper if needed.
Before subming this, we encourage you to:
1. Ensure you nofy us of any changes of contact informaon to avoid unnecessary communicaon delays between us.
2. Ensure there are no materially false allegaons contained in this document.
3. Keep a copy for yourself before subming. If requested, a copy will be provided to you at no cost at the me of receipt
by our agency.
For Oce Use Only:
Received By (print and sign): Date/Time:
Address/Locaon of Incident: Date of Incident: Time of Incident:
Witness Last Name: Witness First Name: Witness Date of Birth or Age: Witness Phone Number:
Witness Address: City: State: Witness E-Mail Address:
Name or Badge Number of Member 1: Name or Badge Number of Member 3: Does a Civilian Recording of Incident Exist? If Yes, Who Possesses It?
Name or Badge Number of Member 2: Name or Badge Number of Member 4: Their Address: Their Phone Number:
Informaon about the incident (aach addional sheets of paper if needed):
Yes No
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-- Instrucons: If you wish to commend one (City of Kingston)

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Completed 23 January 2021

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