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Get Dcjs Form 2012

While DCJS may accept anonymous reports against licensees it will not proceed if the report lacks sufficient information to suggest a regulatory or criminal violation. Complaint Filed By Date Last Name First Name Mailing Address Street/Apt. MI City State Zip Email Address Home Phone Business Phone Fax Complaint Against Business or Individual Name DCJS ID Number Other Individuals or Witnesses Involved in Complaint Name 10/2012 Phone Page 1 of 2 Describe the Complaint in Detail Additional Forms Attached Yes No Is individual / business aware of your complaint Affirmation I wish to complain about the individual/business names above. Do not send original documents unless absolutely necessary and retain a copy of your complaint form and supporting documentation for your files. NOTE DCJS cannot guarantee anonymity. By law all complaints received by DCJS are subject to public disclosure once a case is closed. Therefore if you wish to file anonymously please do not include any personal information on the reporting form or submit any supplemental documents that reveal your identity. O. Box 1300 Richmond VA 23218 Phone 804 786-4700 Fax 804 786-6344 www. dcjs. virginia.gov/pss COMPLAINT FORM IMPORTANT INFORMATION This form is used to register complaints against individuals businesses or training schools about possible violations of the applicable Code of Virginia or Regulations associated with the following programs Private Security Services Bail Bondsman Bail Enforcement Agents Special Conservator of the Peace. COMMONWEALTH OF VIRGINIA Department of Criminal Justice Services Status Hotline 804 786-1132 1-877-9STATUS P. the Private Security Regulations. Please attach copies of all contracts or other documents that will assist in supporting your allegations. Failure to submit supporting documentation may result in the complaint being returned to you for more information and delay the process. Do not send original documents unless absolutely necessary and retain a copy of your complaint form and supporting documentation for your files. NOTE DCJS cannot guarantee anonymity. By law all complaints received by DCJS are subject to public disclosure once a case is closed* Therefore if you wish to file anonymously please do not include any personal information on the reporting form or submit any supplemental documents that reveal your identity. I understand that a regulatory board does not have the authority to require a licensee to return money correct deficiencies or provide other personal remedies. I further understand that decisions regarding this complaint are at the discretion of the Virginia whether disciplinary action against this individual/business should be considered* I certify that the above statements are true and accurate to the best of my recollection* Signature mm/dd/yy. the Private Security Regulations. Please attach copies of all contracts or other documents that will assist in supporting your allegations. Failure to submit supporting documentation may result in the complaint being returned to you for more information and delay the process.

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