Fillable Printable Personnel Complaint Form
Fillable Printable Personnel Complaint Form
Personnel Complaint Form
LT-107 (Rev. 1/07)
Date Received:
Time Received:
Date Closed:
1.
2.
3.
Communication Media:
4. NAMES, ADDRESSES AND TELEPHONE NUMBERS OF WITNESS OR OTHER COMPLAINANTS
(Details on next page)
Date: Date:
District:
Rank / Name:
Rank / Name:
Rank / Name:
Rank / Name:
District:
COMPLAINT RECEIVED BY:
District:
Other
Information:
COMPLAINANT IDENTIFICATION
ACCUSED IDENTIFICATION
District:
Telephone
Home:
Telephone
Business:
Business
Address:
Name:
Home
Address:
Personnel
Policy
Other:
NORTH CAROLINA DIVISION OF MOTOR VEHICLES
LICENSE AND THEFT BUREAU
PERSONNEL COMPLAINT FORM
Type of Complaint Filed:
LT-107 (Rev. 1/07) (continued)
5.
ADDITIONAL PAGES / ATTACHMENTS? YES NO
DETAILS OF THE COMPLAINT
Obtain complainant's written report, if possible and attach. Include date and time of incident(s).
NAME OF MEMBER COMPLETING REPORT SIGNATURE DATE
NORTH CAROLINA DIVISION OF MOTOR VEHICLES
LICENSE AND THEFT BUREAU
PERSONNEL COMPLAINT FORM
(continuation page)
