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Grievance Information Sheet_CNRH
Please complete the form below to submit a grievance. All fields are required to file your grievance. The information you provide will be sent to Emmanuel DeJesus and forwarded to the appropriate representative for your case. All information provided will be kept confidential in accordance with law.
First name:
Last Name:
Email Address (non .mil):
Phone Number:
Supervisor's Name:
Work Site/Duty Location:
Date Violation Occurred or Date that you became aware of the Violation:

Description of Grievance:

Limit of 2000 characters

More in-depth information will be collected at the first meeting with your representative.


Any Documentation:

If none, write "none"

Identify disposition of documents: For Example:

Letter of Caution (copy on hand)  or

Letter of Counseling (Supervisors file) etc.

Remedy Requested:

*note: not all remedies are appropriate, your representative will provide explanations / aleternatives if your remedy is not appropriate.

By signing my name in the box below, I give consent to the Federal Police Officers of Hawaii and Affiliates (FPHA) to use the information I provided herein to pursue a grievance or other appropriate resolution as deemed appropriate by the FPHA. I further consent to having this information shared with appropriate representatives of the FPHA in the pursuit of a resolution.

Type your name in the box to the right to digitally sign the consent agreement above.

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