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
MM slash DD slash YYYY
Signature of Person Receiving Complaint or Commendation.
Date
MM slash DD slash YYYY
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Criminal Division Agent Complaint/Commendation Form