In the heart of Illinois' commitment to ensuring the rights and privacy of its employees, the Illinois Department of Labor provides a pivotal tool known as the Personnel Records Review Act Complaint Form (Il452Pr01). This form serves as a foundational piece in the architecture designed to safeguard employee rights, offering individuals the opportunity to address grievances related to their personnel records. It meticulously outlines several key areas such as claimant information—capturing essential details ranging from personal contact information to the duration of employment. It shifts focus to employer specifics, requiring a comprehensive snapshot of the business's contact details and workforce size. With precision, the form queries about the last review date of records, specific items the employee wishes to review, and whether any refusal or unauthorized disclosure of disciplinary records occurred. Critical too is its provision for representation, allowing claimants to specify if an attorney or union representative will act on their behalf. Moreover, it delves into disputes regarding the accuracy or appropriateness of the content within these records, raising questions about unauthorized records of an employee’s personal affiliations or activities. Additionally, it touches upon other potential complaints under the Act. A notable aspect is the requirement for the claimant's acknowledgment regarding the disclosure of the complaint to the employer, emphasizing the significance of transparency and the veracity of the information provided. The thoroughness of the IL452Pr01 form exemplifies its role as an essential instrument for employees seeking recourse for grievances related to their personnel records.
| Question | Answer |
|---|---|
| Form Name | Form Il452Pr01 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Personnel Records Review Act Complaint FOrm personnel records review act complaint form |
PERSONNEL RECORDS REVIEW ACT |
Complaint Form |
Illinois Department of Labor |
PLEASE PRINT OR TYPE ALL INFORMATION |
160 N. LaSalle Street, Ste. |
|
Chicago, Illinois 60601
FOR OFFICIAL USE ONLY
File Number:
Date Received:
CLAIMANT INFORMATION:
Your Name
Address
City |
|
|
|
|
|
|
|
|
|
State |
|
Zip |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Home Telephone |
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dates of Employment: From |
|
|
to: |
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
|
(Mo/Day/Year) |
|
|
|
|
(Mo/Day/Year) |
|
|
|
|
|
|||||
Have you been laid off subject to a recall? |
Yes |
|
No |
Recall date: |
|
|
|
|
|
|||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EMPLOYER INFORMATION:
Business Name
Address
City |
|
|
State |
|
Zip |
|||||
|
|
|
|
|
|
|
|
|
|
|
Contact Name |
Phone Number |
|
|
|
||||||
|
|
|
|
|
|
|
|
|
|
|
Total Number of Employees: |
|
|
|
|
|
|
||||
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
GENERAL INFORMATION:
1.Date of last review of records
2.Which specific item(s) do you wish to review?
3.Has your employer refused you access to your records? Yes No Reason stated:
4.Has your employer without notice or authorization disclosed your disciplinary records? Yes No If yes, which company representative disclosed your disciplinary records? How? When? To whom?
Page 1 of 2
FORM IL452PR01
5.Is there a representative (e.g. attorney or union) whom you are authorizing to obtain a copy of your records? Yes No If yes, please provide his or her name and address:
6. Is there any information in the records with which the employee disagrees and for which the employee is seeking a correction, removal or
attachment or a rebuttal by employee? |
Yes |
No |
If yes, please list the document(s) with type/name and date(s):
7.Has your employer gathered or kept a record of your associations, political activities, publications, communications or
If yes, give specifics:
8. Other complaints under this Act:
Please read carefully before signing
I am requesting the assistance of the Illinois Department of Labor in the handling of this complaint. I realize it is necessary for the Department to disclose the existence and nature of this complaint and to reveal my name to my (former) employer. I hereby certify that all the information provided in this form and complaint is true and correct to the best of my knowledge and belief.
Signature |
|
Date |
(must have original signature)
Page 2 of 2
FORM IL452PR01