OSI www Agent Commendation

Criminal Division Agent Complaint/Commendation Form
Complete and submit the form below; your contact information is not required.
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Agent(s) for whom complaint or commendation is being filed, or other identifying marks
Name
First Last
Name
First Last
ID#

Vehicle
Other
Name(s)/Address/Phone Number or Other Identifying Information Concerning Witnesses:
Statement of Allegations:

I understand that this statement will be submitted to the OSI Criminal Division and may be the basis for an investigation. Further, I sincerely and truly declare and affirm that the facts contained herein are complete, accurate, and true to the best of my knowledge and belief. Further, I declare and affirm that my statement has been made by me voluntarily, without persuasion, coercion, or promise of any kind. I understand that, under the regulations of the OSI Criminal Division, the Agent on whom a complaint is filed will be entitled to a hearing before a board of inquiry. I understand that I may be required to appear at the OSI Criminal Division for further interview(s) or provide other investigative assistance as necessary. By signing and filing this complaint, I hereby agree to appear before a board of inquiry, or grievance board, if one is requested by the Agent, and to testify under oath concerning all matters relevant to this complaint.
Signature
Date
Date Format: MM slash DD slash YYYY
Signature of Person Receiving Complaint or Commendation.
Date
Date Format: MM slash DD slash YYYY
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Criminal Division Agent Complaint/Commendation Form