Department of Business and Professional Regulation (DBPR)
Office of Inspector General

Complaint Form (Your specific contact information)
First Name:
Last Name:
Email Address:
Home Mailing Address:
City:
State:
Zip:
Phone Number:	-
Work Address:
City:
State:
Zip:
Phone Number:	-
Are you a current or former state employee, state agency contract employee, or applicant for state employment? Yes   No Has this issue been reported to any other party? Yes   No If Yes, Whom? When did you contact this person and what were the results? : Information about the Employee, Individual or Provider who is the subject of this complaint :
First Name:
Last Name:
Address:
City:
State:
Zip:
Telephone:	-
Enter the Division/Bureau/Area in which the person(s) are employed. If you are not sure of the correct location, enter "I Don't Know".
Division/Bureau/Area:
Select suspected violation (select all that apply) Falsified official records Created false or ficticious client files Wrongful use of position, employees, or equipment for personal gain Wrongdoing by management Retaliation against an employee Revealed confidential information Improper use of public money Contract fraud Did not follow laws, rules or policies when making a contract or purchase In contracts or making purchases the employee takes bribes, makes illegal bids, receives awards or fails to monitor Excessive use of force Conduct unbecoming a public employee
When submitting a complaint, please be as specific as possible. Give the name(s) of the DBPR employee(s) or service provider who committed a wrongdoing such as falsification of records, fraud, waste, or mismanagement of State personnel, equipment, or monies. State exactly what happened. Provide witness' names and how to contact the individual(s), if known. Do you know the location of any records or documents to support your complaint? If so, please provide details of what they are and where they are located. ** Complaints must be submitted in writing and will be reviewed upon receipt. A determination will be made either to open an investigation or submit to the appropriate office for handling. The more specific information that you provide us, the better we are able to assist you.
If mailing the Complaint Form, please send to the address shown and attach copies of any related documents.	Office of Inspector General 1940 N. Monroe Street Tallahassee, FL 32399-1018 850.414.6700 850.921.2683 (Fax)

** Indicates mandatory field