Ethics Complaint Form

Name

Agency

Division

Current Position

Day Phone

Night Phone

Best time and number to call

E-mail Address*

Confirm E-mail Address*

Home or mailing address

City

State

Zip

Please file a separate form for each state employee or officer who you believe has violated the Ethics in Public Service Act.

Name*

Agency*

Division

Position

Phone

Location

Subject's Supervisor(s)

Supervisor's Position(s)

Supervisor's Phone

1. What type of ethics violation(s) are you reporting?*

2. When and where did the ethical violation(s) occur?

3. Please describe the ethical violation(s) in detail*

The more detailed information you provide us, the better we will be able to assess your concerns.

4. Where can we find, or can you provide, additional documentation to support your assertions?

Please mail hard copies of documents to PO Box 40149, Olympia, WA 98504

4a. File Attachments

You may upload up to 5 files with a total file size limit of 20 megabytes.

Accepted Document Types: TXT, DOC, DOCX, XLS, XLSX, PDF
Accepted Image Types: JPG, TIF, TIFF, PNG, JPEG

Upload Attachments:

5. Are there other witnesses? If so, please provide their contact information.

6. How do you know about the information you are disclosing here?

Name:*

Declared this date:*