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Complaint Form
This is a form to be used by Crawford County employees to file a complaint.
Crawford County Employee Complaint Form
Name: _____________________________ Date:
_____________________
SSN: _____________________________ DOB: _____________________
Telephone: _____________________________
Department: _____________________________ Title: _____________________
Supervisor: _____________________________ Date: _____________________
Please list each occurrence separately. Attach additional paper if needed.
Date of Occurrence:__________________
Describe occurrence:
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Actions you have taken to remedy situation:
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Have you notified your supervisor? [ ] Yes [ ] No If Yes, please describe what actions your supervisor took. If No, please explain why not.
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Please return form to:
Crawford County
Human Resources
PO Box 249
Girard, KS 66743
Playground Grant Funding Available
Deadline to file for office
