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2. 
3. Rohnert Park Department of Public Safety

   Commendation and Complaint Form

5. First Name*
6. Last Name*
8. Phone Number*
9. Email Address
11. Gender
12. Age
13. Date of Birth*
    Date of Birth
15. Address
17. City
18. State
19. Zip Code
21. Date and Time of Incident*
    Date and Time of Incident

    Date and Time of Incident
22. Name and badge #'s of employee(s) involved
24. Witness Name
25. Witness Email Address
27. Witness Address
29. City
30. State
31. Zip Code
33. Witness Phone Number
35. Description of Incident*
37. Reports of Police Misconduct

    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 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 this is the case, you have the right to make the complaint and have it investigated if you believe an officer behaved improperly. Complaints and any reports or findings relating to complaints must be retained by this agency for at least five years.

39. Signature*

    Please type First and Last name affirming submission of the form

40. Date*
    Date
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

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