Ccl 0093 Pro Se Complaint For Administrative Review
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1(Rev. 9/6/00) CCL 0093
IN THE CIRCUIT COURT OF COOK COUNTY , ILLINOIS
________________________________________________
PLAINTIFF
vs.
NO. ____________________________
ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY
an administrative agency in the State of Illinois;
DIRECTOR OF ILLINOIS DEPARTMENT OF EMPLOYMENT
SECURITY: BOARD OF REVIEW, and administrative agency
in the State of Illinois:
________________________________________
employer,
DEFENDANTS
PRO SE COMPLAINT FOR ADMINISTRATIVE REVIEW
Now comes the Plaintiff ____________________________________________________________ pursuant to
Chapter 735 ILCS 5/3-101 through 735 ILCS 5/3-112 inclusive and complains of the Defendants, ILLINOIS
DEPARTMENT OF EMPLOYMENT SECURITY: DIRECTOR OF THE ILLINOIS DEPARTMENT OF
EMPLOYMENT SECURITY; BOARD OF REVIEW, administrative agencies of the State of Illinois:
__________________________________________________________________ (employer) and alleges as follows:
1.
Plaintiff resides in Cook County, Illinois.
2.
On ________________________________, 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 No. 1,
because said decision is not in accordance with the law.
4.
_____________________________________________ (employer) was a party of record in the administrative
proceedings sought to be reviewed in the 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.
____________________________________________
Atty. No.:__________________
Plaintiff Pro Se
Name: ________________________________________________
Atty. for: ____________________________________________
Address: ____________________________________________
City/State/Zip: ________________________________________
Telephone: __________________________________________
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
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