"Opt out Request Form" - Illinois

Opt out Request Form is a legal document that was released by the Illinois Department of Human Rights - a government authority operating within Illinois.

Form Details:

  • Released on April 1, 2020;
  • 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 printable 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 "Opt out Request Form" - Illinois

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CASENO CPLAST 6 Volu ntary Withdrawal Request Form.doc m
STATE OF ILLINOIS
DEPARTMENT OF HUMAN RIGHTS
IN THE MATTER OF:
)
)
____________________,
)
)
COMPLAINANT,
)
CHARGE NO.: _______________
)
EEOC NO.: _______________
AND
)
)
____________________,
)
)
)
RESPONDENT.
)
OPT OUT REQUEST FORM
I hereby request to opt out of the investigation and administrative processing of my charge filed against the
above named Respondent with the Illinois Department of Human Rights (“IDHR”) (Charge Number
____________________) and the Federal Equal Employment Opportunity Commission (“EEOC”) (Charge
Number ____________________) if applicable.
If EEOC charge number is NOT available: By checking this box, I am also requesting to opt out
of the EEOC investigation that correlates with this charge. Although I do not have the EEOC
charge number available at this time, I understand that EEOC will issue a Right to Sue for the
EEOC charge number that coincides/correlates with the IDHR charge number as part of this Opt
Out process for this charge.
I request that the Director of IDHR issue a Notice of Opt Out of IDHR’s Investigation and Administrative
Process, and of Right to Commence an Action in the Appropriate Circuit Court or Other Appropriate Court
of Competent Jurisdiction. (“Notice of Opt Out”).
I acknowledge that by signing this form and requesting to opt out of IDHR’s investigation, the IDHR will
cease the investigation and administratively close the charge, and that I have 90 days from the receipt of
the Notice of Opt Out to commence an action in the appropriate Circuit Court or other court of competent
jurisdiction.
_______________________________________
Signature
_______________________________________
Date
7 Opt Out Request Form.docm
D/P 1/1/2020
Rev. 4/2020
CASENO CPLAST 6 Volu ntary Withdrawal Request Form.doc m
STATE OF ILLINOIS
DEPARTMENT OF HUMAN RIGHTS
IN THE MATTER OF:
)
)
____________________,
)
)
COMPLAINANT,
)
CHARGE NO.: _______________
)
EEOC NO.: _______________
AND
)
)
____________________,
)
)
)
RESPONDENT.
)
OPT OUT REQUEST FORM
I hereby request to opt out of the investigation and administrative processing of my charge filed against the
above named Respondent with the Illinois Department of Human Rights (“IDHR”) (Charge Number
____________________) and the Federal Equal Employment Opportunity Commission (“EEOC”) (Charge
Number ____________________) if applicable.
If EEOC charge number is NOT available: By checking this box, I am also requesting to opt out
of the EEOC investigation that correlates with this charge. Although I do not have the EEOC
charge number available at this time, I understand that EEOC will issue a Right to Sue for the
EEOC charge number that coincides/correlates with the IDHR charge number as part of this Opt
Out process for this charge.
I request that the Director of IDHR issue a Notice of Opt Out of IDHR’s Investigation and Administrative
Process, and of Right to Commence an Action in the Appropriate Circuit Court or Other Appropriate Court
of Competent Jurisdiction. (“Notice of Opt Out”).
I acknowledge that by signing this form and requesting to opt out of IDHR’s investigation, the IDHR will
cease the investigation and administratively close the charge, and that I have 90 days from the receipt of
the Notice of Opt Out to commence an action in the appropriate Circuit Court or other court of competent
jurisdiction.
_______________________________________
Signature
_______________________________________
Date
7 Opt Out Request Form.docm
D/P 1/1/2020
Rev. 4/2020