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2. I,
3. do hereby make the following statement of my
5. own free will and accord concerning
8. which occured on/at
17. Detailed Statement
19. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
21. Electronic Signature
23. Address
25. City
26. State
27. Zip Code
29. License/ID# or SS#
30. Date of Birth
    Date of Birth
32. Phone Number
33. Cell Number
34. Work Number
36. Officer
38. Every investigator or supervisor assigned to investigate a personnel complaint or other alleged misconduct shall proceed with due dilligence in an effort to complete the investigation within one year from the date of discovery by an individual authorized to initiate an investigation.
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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