Citizen Complaint

Complaint Against Employee

VENTURA POLICE DEPARTMENT

CITIZEN COMPLAINT FORM

Language*

CAD Incident #

Type of Complaint

Date of Complaint*

Time of Complaint*

Individual Filing the Complaint

Please provide as many details as possible.

Complainant is a minor/needs help.

Yes

Information of individual completing the form on behalf of another:

First Name

Middle Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Relationship to Complainant

I want to remain anonymous.

First Name

Middle Name

Last Name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Age

Race

Gender

Driver’s License #

Disability

Type of Disability(s)

Best time to contact?

Primary Language Spoken

Are you able to communicate in English?

Arrested?

Citation Number

Injury Information

Was complainant injured during the incident?

Yes

Type of Injury

Severity of Injury

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Attorney Information

Attorney's Name

Attorney's Phone

Witness Remove

Please enter as many witnesses as possible so we can investigate this complaint thoroughly.

Witness Information

First name

Middle name

Last name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Age

Race

Gender

Driver’s License #

Relationship to Complainant

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship to Employee

Witness

Employee Remove

Please enter the employee’s descriptive information to the best of your recollection.

Employee Information

Employee #

First name

Middle name

Last name

Age

Race

Gender

In Uniform

Division

Section

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Employee

Incident

Please thoroughly describe the employee(s) conduct.

Date of Incident

Day of Incident

Time of Incident

Incident Location

Address

City

State

Zip

Incident Description

Supporting Documentation

Attachment(s) supporting complaint:

File Name	Created
No attachment available
		View

Complaint Against Employee Preview

VENTURA POLICE DEPARTMENT

CITIZEN COMPLAINT FORM

Language

CAD Incident #

Type of Complaint

Date of Complaint

Time of Complaint

Individual Filing the Complaint

Please provide as many details as possible.

Complainant is a minor/needs help.

Information of individual completing the form on behalf of another:

First Name

Middle Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Relationship to Complainant

I want to remain anonymous.

First Name

Middle Name

Last Name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Age

Race

Gender

Driver’s License #

Disability

Type of Disability(s)

Best time to contact?

Primary Language Spoken

Are you able to communicate in English?

Arrested?

Citation Number

Injury Information

Was complainant injured during the incident?

Type of Injury

Severity of Injury

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Attorney Information

Attorney's Name

Attorney's Phone

Witness

Please enter as many witnesses as possible so we can investigate this complaint thoroughly.

Witness Information

First name

Middle name

Last name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Age

Race

Gender

Driver’s License #

Relationship to Complainant

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship To Employee

Employee

Please enter the employee’s descriptive information to the best of your recollection.

Employee Information

Employee #

First name

Middle name

Last name

Age

Race

Gender

In Uniform

Division

Section

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Incident

Please thoroughly describe the employee(s) conduct.

Date of Incident

Day of Incident

Time of Incident

Incident Location

Address

City

State

Zip

Incident Description

Supporting Documentation

Attachment(s) supporting complaint:

File Name	Created
No attachment available

I confirm that I have read understood the "Electronic Record and Signature Disclosure" and consent to use electronic records and signatures.

PENAL CODE 148.6(a)(2):

Any law enforcement agency accepting an allegation of misconduct against a peace officer shall require the complainant to read and sign the following information advisory:

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 CAE, YOU HAVE THE RIGHT TO MAKE THE COMPLAINT AND HAVE IT INVESTIGATED IF YOU BELIEVE AN OFFICER BEHAVED IMPROPERLY. CITIZEN COMPLAINTS AND ANY REPORTS OF FINDINGS RELATED TO COMPLAINTS MUST BE RETAINED BY THIS AGENCY FOR AT LEAST FIVE YEARS.

Signature

Clear