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2. 
3. Employee Complaint Form

   This form should be used exclusively to report alleged misconduct by an employee of the Mount Vernon Police Department. If you have any questions about this process or form, please call the Internal Affairs Unit at (914)665-2599 or by email at IAB@pd.cmvny.com

   A supervisor will be in contact with you shortly to start the investigatory process. You will be notified of the outcome of the investigation.

7. Complainant Demographics (Leave Blank if you wish to submit this anonymously)
9. Name
10. Email Address
12. Address
14. City
15. State
16. Zip Code
18. Cell Phone Number
19. Landline Number
23. Incident Information
25. Incident Number (If known)

    Please type the incident number, if known

26. Incident Date and Time (if Known)*

    Please type the date and time of the incident 

28. Incident Location*

    Please give address, including apartment, if possible

32. Mount Vernon Police Department Employees involved
34. 1st Officer Badge Number

    Please enter badge number, if known

35. 1st Officer Name

    Please enter Officer Name, if known

36. 1st Officer Sex
    -- Select One --MaleFemaleUnknown

    Enter Sex of Officer

37. 1st Officer Race
    -- Select One --WhiteBlackHispanicAsian Unknown

    Enter Officer Race, if known

39. 2nd Officer Badge Number

    Leave Blank if only one Officer involved

40. 2nd Officer Name

    Leave blank if only one Officer involved

41. 2nd Officer Sex
    -- Select One --MaleFemaleUnknown

    Leave blank if only one Officer involved

42. 2nd Officer Race
    -- Select One --WhiteBlackHispanicAsianUnknown

    Leave blank if only one Officer involved

46. Witness Information
48. 1st Witness name

    Please give full name, if known

49. 1st Witness Address

    If known

50. 1st Witness phone number

    If known

52. 2nd Witness name

    Leave blank if only one witness

53. 2nd Witness Address

    Leave blank if only one witness

54. 2nd Witness phone number

    Leave blank if only one witness

58. Complaint Narrative

    Please utilize this space to explain the nature of the complaint, being as specific as possible.

60. Narrative*
62. Media Upload

    Please upload any pertinent pictures or files to here (note: it may not be possible to upload complete video files due to server constraints, in that case the investigating Supervisor will request it at the time of investigation).

64. Attach your files here
66. 'Sign' your complaint by placing your name in the boxes below. If you wish to submit anonymously, please type 'anonymous' in both the first and last name boxes below.
68. First Name*
69. Last Name*
71. Date and time of submission
    Date and time of submission

    Date and time of submission
Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit Submit and Print

* indicates a required field