File a Complaint

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Complainant Information

Identification of Accused Employee(s)

Identification of Accused Employee

Identification of Accused Employee

Witness Information

Witness Information

The undersigned hereby certifies that the information contained in this complaint is true and complete to the best of my knowledge and belief. I understand that making a false report to a law enforcement agency is a violation of North Carolina law and may subject me to criminal prosecution and/or civil liability. My signature below acknowledges that I have received a photocopy of this complaint report and that I have been informed of the complaint processing procedure.

Placing your name in the signature block has the same effect as signing your name in pen on a written document *