Complaint Form
We are sorry to hear that you had an unpleasant experience. At employU, we strive to offer the best possible experience for all of our clients, partners, and staff. Please complete this form and we will address your concerns with the appropriate team(s) and respond to you as soon as possible if you choose to include your contact information.
Submission by:
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Individual wanting to submit a complaint
Employee reporting a complaint received via another outlet
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Please use this form if you are an individual submitting a complaint
I wish to remain anonymous
Yes
No
First and Last Name
Best method of contact
Phone
Text message
Email
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
Your involvement with employU
*
Client or Parent/Guardian of a Client
Business
Other
Name of persons involved in incident
Name of Business
City business is located
If you selected "Other" please list your involvement with employU here
*
Which services were received?
Adult Employment Services
Youth Services
Vocational Evaluation Services
Psychological Evaluations
WIPA - Work Incentive Planning and Assistance
Other
employU representative worked with
Date of incident
*
Describe your situation and/or concern in detail so we can address it with the correct team members.
*
Desired resolution
*
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Employees submitting a complaint on behalf of someone else
Please use this form if you received a complaint through any other outlet and are logging it here
Employee name
*
Date complaint received
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Complainant name
*
Method complaint received
*
Email
Phone
Text message
Google Review
Social media or public online platform
Other
Social media outlet or other online platform name
*
Related client name
*
Employees related to this complaint
*
Complaint details
*
Response to complaint
*
Response reported to
*
Other comments
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Should be Empty: