EXTREMELY IMPORTANT NOTE REGARDING THE ENTRY OF
This form requires the entry of confidential information. Therefore, it is
extremely important for you to close down your browser completely after
submitting this form. This will prevent others from accessing the
information you have entered. To close down your browser, click the "x" in
the top right-hand corner of the browser window.
Before submitting this form please verify that all required information is
fully completed and that all information matches what you would have
provided to the Department of Labor when you originally filed your claim.
You have indicated your address has changed.
Please complete the form below to change your address.
* - Denotes
that I am the claimant indicated below. I understand that the law
provides penalties for making false statements or any
misrepresentation to obtain unemployment benefits.
* Full Name:
(format = ######### - no dashes please)
* Mother's Maiden Name (for
* Date of Birth (for
Email Address: (to contact you
only for confirmation)