WFSA Complaint Form

Complainant Panel
Section
Panel for Demographics
Panel for submission

Worker Freedom of Speech Act (WFSA) Complaint Form

Interested Party Complainant Information

Organization's Name

Address

City

State

Zip Code

Email Address

Phone Number

Interested Party Contact Person

First Name

Last Name

Email Address

Phone Number

I agree to allow the Illinois Department of Labor to contact me via electronic mail (email) about my complaint, including the exchange of documents by email, at the email address provided above.

Yes

Named Party

Employer (company or organization) Name:

Address

City

State

Zip Code

Email Address

Phone Number

Industry

Employer’s Contact Person

First Name

Last Name

Email Address

Phone Number

Alleged Violation

Please describe the alleged violation in the box below, including any resulting discharge, discipline, penalization, or adverse employment action planned or that occurred. You may also submit an attachment by clicking on the “Attachments” button below.

File Attachments

I understand that in general the public has the right, under FOIA, to request most information kept as part of any public record, however, the IDOL, will endeavor to keep the confidentiality of a complainant or witness to the maximum extent allowable by law.

Yes

I hereby certify that the complaint, including attachments, is true and accurate to the best of my knowledge.

Yes

Name

Date

Demographic information

IDOL asks for this voluntary information in order to learn more about the people who file complaints with us. Any information you provide will not be shared or used in relation to your complaint.

What is your race?

What is your ethnicity?

What is your gender identity?

What is your sexual orientation?

Do you have a disability?

What is your primary language?

WFSA Complaint Form

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