Arizona Department of Public Safety

ARIZONA STATE TROOPERS

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File a Commendation

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Today's Date

Month

Day

Year

Subject of Commendation

Employee Name

Classification/Rank (i.e. Trooper, Captain, etc)

Badge No.

Location

Phone No.

Submitter's Information

Submitter's Name

Submitter's Phone No.

Submitter's Email

Address

City

State

Zip Code

Submitter's Employer

Work Phone No.

Address

City

State

Zip Code

Witness Information (if applicable - click to expand)

Witness Name

Phone No.

Address

City

State

Zip Code

Witness Name

Phone No.

Address

City

State

Zip Code

Date of Incident (MM/DD/YYYY)

Month

Day

Year

Time Of Incident

Hour

:

Minute

am

pm

Incident Location

Commendation

be specific, list other employees involved, badge numbers, classifications / ranks (i.e.- officer, sergeant, etc) and vehicle descriptions

Commendation Taker (Click to expand)

This is for use by the Arizona Department of Public Safety/Arizona Counter Terrorism Information Center ONLY.

Name

Badge

Classification

Work Phone Number

Phone number of the employee taking the complaint

Location Code

Date Reported

Month

Day

Year

Time Reported

Method

Statement of Truthfulness *

I affirm that all of the information I have provided on this form and in any accompanying document is true, complete and correct.

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