Employee Complaint Form - adelwholesalers

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Adel Employees

EMPLOYEE COMPLAINT FORM

1101 STATE STREET BETTENDORF, IA 52722 – 955 33RD AVE SW, CEDAR RAPIDS, IA 52404

Employee Complaint Form

Employee Infomation

Your Name *

Your Name

First

First

Last

Last

Date *

Your Title *

Phone *

Email *

Your complaint is against: *

Employee

Management

Customer

Other

Other (Specify)

Department: *

Plumbing

Heating

Sales

Office Staff

Management

Location: *

Bettendorf

Cedar Rapids

Complaint Information

Date of Incident: *

Time of Incident *

Please describe the incident in detail: *

If there are others who have witnessed the incident, please provide their names and phone numbers below:

Is this the first time you have raised this concern about this person? *

Yes

No

How would you like to see this incident resolved? *

Do you have any additonal information or complaints? If so, please explain.

Signature:

Print Name *

If you are human, leave this field blank.

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