DFS Employee Misconduct Form

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
PLEASE COMPLETE THE FOLLOWING QUESTIONS TO THE BEST OF YOUR ABILITY.
(DFS Employee Name) Who are you reporting about?
Where are they employed with DFS?
Who else is aware of the activity/problem? (Please give complete names and contact information for each person.)
What specifically did this person do that may be a violation of law, rule, or department policy?
Please list the policy, law, rule, etc, which you believe has been violated.
When did this take place?
Where did this take place?
Have you or someone else reported this to another agency and/or manager and if so, when and to whom?
Any additional information you believe could assist?