Statement of Purpose

The Human Resources Incident Report Form is intended for use by Human Resources or senior level managers and above to capture any report or question that has been reported to you about any violation or potential violation of our Code of Ethics, Conn's policy or the law. We encourage you to use this form to document matters, which meet the descriptions identified in the drop down list provided on this form. This will provide Conn's with relevant data to help us appropriately manage our relations with our associates/employees, our most important asset.

Information captured using this form will be routed to the Investigative team for review and the necessary next steps. Please note you may be contacted to provide further information or conduct follow-up inquiries.

Items marked with a diamond are required fields.

Logged by (You, the person entering this report)

 
(By checking this box you agree to allow EthicsPoint to store your information in a “Cookie” on this computer.)
Your Name &
Contact Information
 
Prefix
(Select One)
First Name
 
M.I.
Last Name

Job Title
Associate ID
 

 
Phone Number (Preferred)

Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)
   

Reported by (The person who brought this incident to the company's attention)

Same Person
Was this issue/event raised by another individual other than yourself?
(Select One)
Reporter Name &
Contact Information
Relationship to Conn's
(Select One)
“Other” Relationship

 
Prefix
(Select One)
First Name
 
M.I.
Last Name

Job Title
 
Associate ID
 

 
Phone Number (Preferred)

Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)
   

Incident Location & Address

Location
Select the incident location by clicking on the “Look Up” button below
~
Store ID
 
~
Location
 

~
Street/Mailing Address
 

~
City
 
~
St./Province
 
~
Zip/Post Code
 
~
Country
 
   

Issue Selection

Additional Issue(s)
*
Additional issues added to this form will be for used reporting purposes only and do not impact the questions or information requested. If there is any significant, important, or vital information regarding "Issue Two" or "Issue Three", please provide that information in the "Details" section of the report on the following page.

Incident Details

Date
 
Do you know the exact incident date?
(Select One)
 
Date of Incident

(Format: mm/dd/yyyy)
 
Time of Incident
(Select One of Each)
 
Approximate Date/Time of Incident

 
Details
Please provide all details regarding the alleged violation, including the locations of witnesses and any other information that could be valuable in the evaluation and ultimate resolution of this situation.
 
   

Participants -  (Persons involved in this incident.)

 
 
Please identify all parties involved in this incident.
To add a participant click the Add button below.
«
»
+
Role & Relationship
Role in Incident
(Select One)
“Other” Role

Relationship to Conn's
(Select One)
“Other” Relationship
Name & Contact Information
 
Prefix
(Select One)
First Name
 
M.I.
Last Name

Job Title
 
Associate ID
 

 
Phone Number (Preferred)

Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)
 
  • Add

Password

 
Password
Re-Enter Password
Password

(Passwords must be at least four(4) characters in length.)

Submit

Upon submission of this form, you will be issued a Report Key. Please write this information down along with your password, in a secure and private place. Neither your report key, nor your password, can be recovered, or reset once this report has been submitted.

Using your Report Key and Password you can "Follow-Up" on this report returning to this form and clicking on the “Follow-up” link at the top of the page.

Follow-up will allow you to:

  • Upload documents
  • Respond to follow-up questions/comments
  • Provide additional information
   
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