State of Wisconsin Department of Administration Division of Personnel Management DOA-15807-G (R9/2020) § 230.34 & § 111.80, Wis. Stats.	CASE NUMBER (If applicable): [Case Number]
EMPLOYEE INVESTIGATION REPORTS INVESTIGATIONS INVOLVING CRIMINAL MATTERS
INSTRUCTIONS:	HR determines appropriate option below. Investigator will read designated option aloud to employee prior to conducting the investigatory interview and obtain appropriate signatures.
SUBJECT OF INVESTIGATION (Last Name, First Name, M.I.)	JOB TITLE OR CLASSIFICATION
In investigations into conduct which may constitute a crime as well as a dischargeable offense, neither a public employee’s statements nor refusal to answer will be allowed as grounds for discharge where he or she is required to answer the questions, unless the employee has been warned that their statements cannot be used against him or her in criminal proceedings.
CHECK ONE OPTION BELOW
NOTICE OF RIGHTS
This is an administrative investigatory interview. Staff has the right to personal representation. The results of this interview will be used for employment purposes. This is not a criminal investigation but since the work rules prohibit illegal conduct, inquiry into illegal acts may be pursued to determine whether there has been a work rule violation. The charges involved here are serious and may involve future criminal charges.
Require answers from the employee: You are required to answer all questions truthfully and completely to the best of your ability. If you refuse to answer, you may be disciplined for that refusal, in addition to any other discipline which may be imposed for other misconduct. Any information or evidence you furnish in response to questions asked of you during this interview, or any information or evidence which is gained by reason of your answers, may not be used against you in criminal proceedings.
Employee’s choice to remain silent or answer questions: This is not a criminal investigation, but inquiry into illegal acts might be pursued to determine whether there has been a work rule violation. The allegation(s) involved here are serious and may involve future criminal charges. Management is not going to require you to make any statement or answer any questions at this time. Therefore, if any answer or statement you give during this interview could be self-incriminating, it could be used against you in a criminal prosecution. If you choose not to answer questions or make a statement, management will make a decision based on those facts and sources of information available to it.
SUBJECT OF INVESTIGATION SIGNATURE	DATE SIGNED:
PRINT/TYPE INVESTIGATOR NAME (Last Name, First Name of each)