WBComplaint Form Entry

Online Whistleblower Complaint Form

Full Name:Contact Information

Relationship to MyRUCK.ai

EmployeeEmployerOther

Date of Incident:Location/Department Involved:Individuals Involved (Do not include witness contact information here):Description of the Incident:

Please describe the activity that led to the alleged retaliation (e.g., reporting a violation, participating in an investigation):

How and when did the employer become aware of your protected activity?

Describe any adverse actions taken by the employer against you:

Why do you believe the adverse action was taken against you because of your protected activity?

Please list any evidence you have that supports your complaint (documents, emails, etc.):

What resolution are you seeking?

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