Santa Cruz — Complaint Form - English

Source: https://shf.santacruzcountyca.gov/Portals/1/County/sheriff/formsdocs/2025%20Sheriff%27s%20Complaint%20Form-English.pdf

Sparse pages use OCR; original PDF remains authoritative.

County of Santa Cruz

Sheriff-Coroner

5200 Soquel Ave Santa Cruz, CA 95062 (831) 454-7600 FAX: (831) 454-7604

Chris Clark Sheriff-Coroner

Complaint Form Cover Letter

You have the right to make a complaint regarding conduct by an employee of the Santa Cruz County Sheriff’s Office without concern for reprisal or retaliation. You are entitled to a copy of your statement at the time you file the allegation. The Sheriff’s Office will investigate your allegation(s). When the investigation is complete, the Sheriff’s Office may take personnel action against the employee if it determines misconduct occurred, or this agency may conclude that there is insufficient evidence to warrant personnel action. A notice regarding the finding of the investigation will be provided to the complainant within 30 days of the completed investigation. Complaints and any reports or findings will be retained for at least five years.

Complainant's Name, Printed

Complainant's Signature Date

Santa Cruz County Sheriff’s Office

Complaint Form Complainant’s LAST Name, First, Middle ❏ Male ❏ Female Race: ❒Hispanic Date of Birth: ❒Asian ❒White ❒Black Other Address City/Zip Phone : Email:

Complete this Portion if Complainant is a Minor or if Assisted by an Attorney LAST Name, First, Middle Relationship to Complainant:

Address City/Zip Phone: Email:

Location of Occurrence: Day: Date: Time: ❒AM

❒PM

Identity of Involved Personnel Badge No. Name / Vehicle No., etc. Sex Race

Brief Narrative Using Own Words. (If you need more space, use additional narrative page)

Were you Injured? ❒ No ❒ Yes (Describe)

Witness Name (LAST, First, Middle) Address City/Zip Phone (Include Area Code)

Does your complaint involve any of the following criteria: race or ethnicity (including color), nationality, age, religion, ❒Yes gender, gender expression, sexual orientation, mental disability, or physical disability? ❒No

Complainant’s Signature X Date

For Official Use Only Complaint Received by Date Received ❑ Walk-in ❏ Mail ❏Fax EMPLOYEE RECEIVING ALLEGATION POSITION DIV I.D. DATE