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Date/Time of Incident*: Location of Incident*:
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By clicking below on the submit button I understand that this statement of complaint will be submitted to the Longwood University Public Safety and may be the basis for an investigation. Further, I affirm that the facts contained herein are complete, accurate, and true to the best of my knowledge. Further, I declare and affirm that my statement has been made by me voluntarily without persuasion, coercion, or promise of any kind.
I understand that, under the regulations of the department, the employee against whom this complaint is filed may be entitled to a hearing. By signing and filing this complaint, I hereby agree to appear before a hearing board, if one is requested by the employee, and to testify under oath concerning all matters relevant to this complaint.
I have read and agree to the terms above.
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