This is a downloadable form that is free of any kind of copyrights. It can be altered in any way. It is meant to file legitimate complaints against Gloucester County Employees when needed.

1. Gloucester County, Virginia
Member Of The Public Complaint Form;
Date:
To: Human Resource Manager, Gloucester County, Virginia;
I am filing a complaint today against, 1.) , of
2.) ,
according to the Gloucester County Personnel Policies and Procedures, specifically sections
10.1 and 10.3 of said procedures. The section that reads as follows: Use of offensive,
abusive, threatening, coercive, indecent or discourteous language towards supervisors, other
employees, or members of the public. As a member of the public, I feel that an offensive
abuse has taken place by the above mentioned person.
Please Describe Nature Of Perceived Offense: (Use as much space as needed. Please
include date, if known, of when offense(s) occurred as well as location if known. Please also
include if there were any witnesses and whether they would be willing to collaborate your
information).
Your Name Notary Public Signature
Your Signature Commission Expires
Today's Date