"Voluntary Withdrawal Request Form (Ca/Sa)" - Illinois

Voluntary Withdrawal Request Form (Ca/Sa) is a legal document that was released by the Illinois Department of Human Rights - a government authority operating within Illinois.

Form Details:

  • Released on May 1, 2012;
  • The latest edition currently provided by the Illinois Department of Human Rights;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Illinois Department of Human Rights.

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Download "Voluntary Withdrawal Request Form (Ca/Sa)" - Illinois

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VOLUNTARY WITHDRAWAL REQUEST FORM
RESPONDENT: ______________________________
COMPLAINANT: ______________________________
I hereby request to withdraw my charge filed against the above named Respondent with the
Illinois Department of Human Rights (Charge Number ____________________) and the Federal
Equal Employment Opportunity Commission (Charge Number ____________________).
Withdrawal is being made of my own free will, without pressure from any organization or
individual.
If I am withdrawing this charge because I have reached a settlement with the Respondent, which
has not been approved by both the Department and the Human Rights Commission, those
agencies cannot enforce that settlement.
I understand that under the Age Discrimination in Employment Act I have seven (7) days to
revoke a settlement.
I further understand that this withdrawal will be effective and the
Department will process this withdrawal on the eighth (8th) day after I sign and date this
withdrawal, unless I timely notify the Department that I am revoking my acceptance of this
withdrawal.
_______________________________________
Signature
_______________________________________
Date
NOTE:
The Department of Human Rights will not accept or process a Voluntary
Withdrawal Request Form with different, additional, edited or changed text from
its standard form above.
#6 – AW - Age
05/12
VOLUNTARY WITHDRAWAL REQUEST FORM
RESPONDENT: ______________________________
COMPLAINANT: ______________________________
I hereby request to withdraw my charge filed against the above named Respondent with the
Illinois Department of Human Rights (Charge Number ____________________) and the Federal
Equal Employment Opportunity Commission (Charge Number ____________________).
Withdrawal is being made of my own free will, without pressure from any organization or
individual.
If I am withdrawing this charge because I have reached a settlement with the Respondent, which
has not been approved by both the Department and the Human Rights Commission, those
agencies cannot enforce that settlement.
I understand that under the Age Discrimination in Employment Act I have seven (7) days to
revoke a settlement.
I further understand that this withdrawal will be effective and the
Department will process this withdrawal on the eighth (8th) day after I sign and date this
withdrawal, unless I timely notify the Department that I am revoking my acceptance of this
withdrawal.
_______________________________________
Signature
_______________________________________
Date
NOTE:
The Department of Human Rights will not accept or process a Voluntary
Withdrawal Request Form with different, additional, edited or changed text from
its standard form above.
#6 – AW - Age
05/12