Fresno Police Department Complaint Form FRESNO POLICE DEPARTMENT INFORMATION ADVISORY FOR PERSONNEL COMPLAINTS You have the right to make a complaint against a Department member for any improper conduct. California law requires this agency to have a procedure to investigate citizen complaints. You have the right to a written description of this procedure. This agency may find that after the investigation, that there is not enough evidence to warrant action on your complaint. Even if that is the case, you have the right to make the complaint and have it investigated if you believe a Department member behaved improperly. Citizen complaints and any reports or findings relating to complaints must be retained by this agency for at least five years. In the event the complaint results in disciplinary proceedings against the officer(s) or employee(s) named, you may be asked to appear before the Civil Service Board of the City of Fresno or any other examining authority. I declare under penalty of perjury that the statement I have given is true and correct. I have read and understand the above statement * Yes FRESNO POLICE DEPARTMENT COMPLAINT FORM Name of Complainant Last Name * First Name * Middle Name Sex Age Date of Birth * Ethnicity/Race Home Address Home Address Home Address Home Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Home Phone * Cell Phone Email Alternate Address Alternate Address Alternate Address Alternate Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Alternate Phone Inmate? Yes No Jail/Prison Name JID/Booking # etc Jail/Prison Address Jail/Prison Address Jail/Prison Address Jail/Prison Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal If you move or change contact numbers, please advise the Fresno Police Department, Duty Office at (559) 621-2375. Failure to provide current information may result in a lack of contact and closing of the complaint. Location of Incident: * Incident Date * Time of Incident 121234567891011 : 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 AMPM Describe any injuries suffered Were injury photos taken? Yes No Photos Taken By Where were the injuries treated Who treated the injuries? Were you Arrested? Yes No Criminal Charges Pending? Yes No Fresno Police Department Report #/Citation # FRESNO POLICE DEPARTMENT OFFICER/MEMBER INFORMATION Badge # Sex Name Race Vehicle # Comments plus1 Add minus1 Remove DETAILS Please describe the incident in detail Please indicate if you have filed this complaint with another City of Fresno department or an outside agency regarding this incident. If so, please note the date and person contacted. Fresno Police Department Fresno City Mayor’s Office Fresno City Manager’s Office Fresno City Council Member Fresno City Office of Independent Review Other Agency Please note this complaint form is only for incidents involving member(s) of the Fresno Police Department. RACIAL PROFILING COMPLAINT REPORTING If your complaint is based on discrimination related to any of the below categories, please list all that apply with the number of persons affected. Nationality Race or Ethnicity Gender Age Religion Gender Identity or Expression Sexual Orientation Mental Disability Physical Disability Complaint type definitions: Race or ethnicity bias is defined as a preformed negative opinion or attitude toward a group of persons, such as Asians, Blacks, or Whites, based on physical characteristics or toward a group of persons of the same race who share common or similar traits in language, custom, and tradition. Nationality bias is defined as preformed negative opinion or attitude toward a group of persons based on their national origin. Gender bias is defined as a preformed negative opinion or attitude toward a group of persons based on their gender. Age bias is defined as a preformed negative opinion or attitude toward a group of persons based on their age. Religion bias is defined as a preformed negative opinion or attitude toward a group of person based on religious beliefs regarding the origin and purpose of the universe and the existence or nonexistence of a supreme being. Examples are Catholics, Jews, Protestants, or Atheists. Gender identity or expression bias is defined as a preformed negative opinion or attitude toward a group of persons based on how that group chooses to identify or express their gender preference. Sexual orientation bias is defined as a preformed negative opinion or attitude toward a group of persons based on sexual preferences and/or attractions toward and responsiveness to members of their own or opposite sexes. Mental disability bias is defined as a preformed negative opinion or attitude toward a group of persons based on mental impediments/challenges, whether such disabilities are congenital or acquired by heredity, accident, injury, advanced age, or illness. Physical disability bias is defined as a preformed negative opinion or attitude toward a group of persons based on physical impediments/challenges, whether such disabilities are congenital or acquired by heredity, accident, injury, advanced age or illness. reCAPTCHA Submit If you are human, leave this field blank.
