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Please fill in the following information. If there is more than one Respondent, please complete a form for each one. Complaints must be filed against an individual, not a company/corporation. NOTE - The ERC cannot consider anonymous complaints. If you file an anonymous complaint, it will automatically be rejected. If your complaint involves a chapter dispute/conflict, please refer to the Chapter Conflict Resolution Program.
Complainant(s) Information - Complaint cannot be filed anonymously
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Your Name |
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Your Address |
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Daytime Phone |
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Evening Phone |
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Your Email Address |
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Information regarding individual against whom the Complaint is filed (the "Respondent"). NOTE - The Respondent must be an individual, not a company/corporation. If your complaint involves a chapter dispute/conflict, please refer to the Chapter Conflict Resolution Program. |
Respondent Name |
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Respondent Address |
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Respondent Phone Daytime |
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Resplondent Phone Evening |
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Respondent Email Address |
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Respondent Association |
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Complaint details
Provide a statement of what you consider to be the essential facts involved in the alleged ethics violation. While not mandatory, HR requests that you include specifically the applicable section(s) of the Company Code of Ethics and Professional Conduct you believe to have been violated. (Note that that the HR will only consider alleged violations of the Code's mandatory standards, not its aspirational standards.) This should be a summary of the most important facts which the Complainant believes support the issuance of a formal ethics complaint. Each fact should be numbered or otherwise identified.
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Essential Facts Of Complaint |
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Similar Proceedings
To the best of your knowledge, are there any other ethics complaints, regulatory complaints, or court actions that have been filed by you or anyone else that relate to the same or similar allegations contained in this Complaint form? If so, identify such complaints or other actions below. If any such actions have concluded, please describe specifically the results and attach relevant documentation. Note: The Complainant should list any actions taken or contemplated that are directed at the same or related complaints. For example, the Complainant should identify any matters filed with state licensure or regulatory boards, courts or other judicial forums, professional organizations, and employers that relate to the issues raised in this Complaint. Note that the HR Ethics Case Procedures state that the HR Department shall not consider a Complaint when civil, criminal, or regulatory proceedings are ongoing.
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Similar Proceedings |
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List all persons you believe have knowledge of the matters you have asserted in this Complaint and a brief description of what each person's knowledge is regarding the alleged violation. Note: Please provide each individual's full name, address, telephone number, and other contact information (e.g., e-mail address, to the extent known). Note that the HR Department is permitted to contact any individual listed here or other individuals as part of its review of any Complaint. |
List Everyone Involved |
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Indicate how many documents you plan to provide and then list all of the documents attached to this Complaint form. If there are numerous attachments, please utilize an indexing format, such as by numbering documents as Attachment 1, Attachment 2, Attachment 3, etc. Note: All documents must be listed by type (e.g., letter, e-mail, memo, certificate, etc.), date, and the name of the individual or organization that prepared it. All documents listed in this section must be submitted along with this Complaint at the same time that this Complaint is submitted. |
How Many Documents |
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List Document Names |
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List all steps you have attempted to resolve the issue with the Respondent prior to the submission of this Complaint form. Be as detailed as possible. |
List Attempts To Resolve |
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Statement and Certification.
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Confirm This Complaint |
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Digital Signature Name |
Date of Complaint |
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