Illinois > Local County > Dupage > Administrative - Civil
Pro Se Petition For Administrative Review (Employment) 3135 - Illinois
| Pro Se Petition For Administrative Review (Employment) Form. This is a Illinois form and can be used in Administrative - Civil Dupage Local County . |
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ADMINISTRATIVE REVIEW-PRO SE COMPLAINT STATE OF ILLINOIS UNITED STATES OF AMERICA 3135 (Rev 07/05) COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT PLAINTIFF -VS- CASE NUMBER 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 (MONTH DAY YEAR) , a final administrative decision was rendered by the Department of 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 (EMPLOYER) was a party of record in the administrative proceedings sought to be 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: Address: City, State Zip: Telephone: ( Date: ) Signature of the Pro-se Plaintiff (* 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
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