Citizen Complaint

Complaint Against Employee

It is important we have a clear understanding of your complaint. To ensure there is no misunderstanding about the basis of your complaint, we ask you to complete the following citizen complaint form. If you are unable to complete this form on your own, you may contact our non-emergency dispatch number at (408) 615-5580 and request the assistance of an on-duty supervisor. For more information about the complaint process visit our website at https://www.santaclaraca.gov/our-city/departments-g-z/police-department/about-us/commendations-inquiries-or-complaints .

If you would like to download the file and submit an electronically scanned copy, please use the links below:

English: https://drive.google.com/file/d/1gVC80gwQiMdykAp8m2OtMwDDPzGn1Ypk/view?usp=share_link

Hindi: https://drive.google.com/file/d/1Y0QfAe2mRIbPa0gkvVzReeiDg2r04Ick/view?usp=share_link

Korean: https://drive.google.com/file/d/17rrpBnA2B6WIa-k8zONUV4VODW7SzvQn/view?usp=share_link

Spanish: https://drive.google.com/file/d/1uaYLa9eJAkQB_qRMyaXw-UPO5zr8Fj9K/view?usp=share_link

Vietnamese: https://drive.google.com/file/d/1X0WdC3PdF64JeXitSr3ob5mdwq6s_LXw/view?usp=share_link

Mandarin: https://drive.google.com/file/d/1f5rB03irya7pVaf7QT_9ouEo3eGVooiN/view?usp=share_link

Language*

CAD Incident #

Date of Complaint*

Time of Complaint*

Individual Filing the Complaint

Please complete the following personal information. If you wish to remain anonymous, you may do so by checking the box below. Anonymous complaints will be treated with the same importance as any other complaint; however, we will be unable to contact you to obtain follow up details which may be necessary for a complete investigation.

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

Additional phone

Additional Email

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

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Employee Remove

Complete as much information about the employee as you can. You may use the “Description of employee” text box field if the employee is unknown.

Employee Information

Employee #

First name

Last name

Age

Gender

In Uniform

Division

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Employee

Incident

Complete as much information about the incident as possible. Complete a summary of the incident along with details of your complaint in the “Incident Description” text box field. You will have an opportunity to explain the incident in greater detail when you speak with a supervisor. You can also attach an additional narrative if you believe more information is needed. You may attach supporting evidence and documentation via the link below. Once you submit your complaint you will have the option to download a copy of your complaint statement for your records.

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

If you would like to download the file and submit an electronically scanned copy, please use the links below:

English: https://drive.google.com/file/d/1gVC80gwQiMdykAp8m2OtMwDDPzGn1Ypk/view?usp=share_link

Hindi: https://drive.google.com/file/d/1Y0QfAe2mRIbPa0gkvVzReeiDg2r04Ick/view?usp=share_link

Korean: https://drive.google.com/file/d/17rrpBnA2B6WIa-k8zONUV4VODW7SzvQn/view?usp=share_link

Spanish: https://drive.google.com/file/d/1uaYLa9eJAkQB_qRMyaXw-UPO5zr8Fj9K/view?usp=share_link

Vietnamese: https://drive.google.com/file/d/1X0WdC3PdF64JeXitSr3ob5mdwq6s_LXw/view?usp=share_link

Mandarin: https://drive.google.com/file/d/1f5rB03irya7pVaf7QT_9ouEo3eGVooiN/view?usp=share_link

Language

CAD Incident #

Date of Complaint

Time of Complaint

Individual Filing the Complaint

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

Additional phone

Additional Email

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

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Employee

Complete as much information about the employee as you can. You may use the “Description of employee” text box field if the employee is unknown.

Employee Information

Employee #

First name

Last name

Age

Gender

In Uniform

Division

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Incident

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

Signature

Clear