Request for Hearing Form

• Attorney Info
• panel1732645833893

* indicates required field

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Date

***This form must be filed with the Civil Service Commission within 15 calendar days after the service of the written charges. If you haven't received confirmation within 24 hours of submitting this form please call our office at 217-782-7373.***

Filing Notice

This form must be filed with the Civil Service Commission within 15 calendar days after the service of the written charges.

Agency Imposing Discipline

Date charges officially approved by the Director of Central Management Services of the State of Illinois

Approved charges resulted in my:

Discharge Suspension for a period of more than 30 days in any 12-month period Demotion

Are you represented by an attorney for this appeal?

No Yes

Attorney Name

Firm Name

Attorney Mailing Address

Attorney Phone Number

Attorney Email

Employee Name

Please include first, middle and last name

Email Address

Secondary Email Address

Alternate Email Address

Mailing Address

Please include unit, apartment, or suite number.

City

State

Zip Code

Telephone Number

Alternate Telephone Number

I understand the Civil Service Commission has jurisdiction over discharges or suspension for a period of more than 30 days within a 12-month period of certified employees that have been approved by the Director of Central Management Services or their designee. 

I also understand that the Civil Service Commission does not have jurisdiction to hear the appeal of employees who have resigned from their positions. 

Yes, I understand

Please check box if you consent to service by email for all notices, decisions, and orders concerning this appeal pursuant to Section 1.150 of the Rules of the Civil Service Commission.  This includes a waiver of Sec. 10-75 of the Illinois Administrative Procedures Act pursuant to Sec. 10-70 of that Act.  (5 ILCS 100)

Yes, I consent

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Form Revised October 19, 2023

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