Pro Se Petition For Administrative Review (Employment)
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Pro Se Petition For Administrative Review (Employment) Form. This is a Illinois form and can be use in Dupage Local County.
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Tags: Pro Se Petition For Administrative Review (Employment), 3135, Illinois Local County, Dupage
3135 (Rev 07/05)
ADMINISTRATIVE REVIEW-PRO SE COMPLAINT
STATE OF ILLINOIS
PLAINTIFF
UNITED STATES OF AMERICA
COUNTY OF DU PAGE
IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT
CASE NUMBER
-VS-
ILLINOIS DEPARTMENT OF
EMPLOYMENT SECURITY, an
administrative agency in the State of Illinois;
DIRECTOR OF ILLINOIS DEPARTMENT
OF EMPLOYMENT SECURITY: BOARD
OF REVIEW, an administrative agency in
the State of Illinois
employer,
DEFENDANT
File Stamp Here
PRO SE COMPLAINT FOR ADMINISTRATIVE REVIEW
Now comes the Plaintiff (Pro-se)
,and complains that
the Defendants: Illinois Department of Employment Security: Director of the Illinois Department of
Security, Illinois Department of Employment Security: Board of Review, both administrative agencies
of the State of Illinois, and
(employer) and alleges as follows: *
1. Plaintiff resides in DuPage County, Illinois.
2. On
, a final administrative decision was rendered by the Department of
(MONTH
DAY
YEAR)
Employment Security; Board of Review, affecting the rights of the Plaintiff.
3. The Plaintiff desires a judicial review of said decision, a copy of which is attached hereto as Exhibit 1,
because such decision is not in accordance with the law.
4. On
was a party of record in the administrative proceedings sought to be
(EMPLOYER)
reviewed in this action.
5. Department of Employment Security: Board of Review is hereby requested to file an answer consisting of
the record of proceedings had before the said administrative agency.
6. The Plaintiff has exhausted all available administrative remedies under the Act and has no further plain,
speedy and adequate remedy in the ordinary course of the law.
WHEREFORE, The Plaintiff prays that said record be judicially reviewed.
Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the
undersigned certifies that the statements set forth in this instrument are true and correct
Name:
Signature of the Pro-se Plaintiff
Address:
City, State Zip:
Telephone: (
Date:
)
(* This action is pursuant to 735 ILCS 5/3-101 through 735 ILCS 5/3-112 inclusive)
CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT ©
American LegalNet, Inc.
WHEATON, ILLINOIS 60189-0707
www.USCourtForms.com
