Connecticut Department of Labor
  Home About Us FAQ News and Notices Contact Us
Unemployment Benefits On-Line Job Seekers Employers Labor Market Information Directions/Office Information

 

Claimant's Appeal To Referee
CLAIMANT'S APPEAL TO REFEREE State of Connecticut
Department of Labor
Employment Security Appeals Division

Use the Tab key to move forward a field and Shift-Tab to move back a field.

Please do not use special characters such as "é" and "â" (for example in words such as "café" or "fiancé", and in some proper names as well) when entering your appeal; we have found that these characters can cause the appeal to be dropped by the system. We are working on fixing this problem.

Please also do not paste text into the text boxes as we've found that problems can be caused by doing this as well.


PARTY FILING APPEAL TO REFEREE: 

LOCAL AMERICAN JOB CENTER WHERE HEARING WAS HELD*: MAILING DATE OF LOCAL AMERICAN JOB CENTER DECISION:
*Please refer to the original hearing notice you received to make the appropriate office selection.

Claimant Information
Claimant Social Security Number:
Claimant Name:
Street:
City:
State:   Zip Code: 
Telephone Number: (

Claimant Agent Information (If Applicable)
Claimant Agent Name:
Street:
City:
State:   Zip Code: 

Employer Information (If Applicable)
Employer Registration Number:
Employer Name:
Street:
City:
State:   Zip Code: 

I disagree with the examiner's decision for the following reason(s). (If you received more than one decision, please indicate which decision(s) you are appealing.)


 

If this appeal is not transmitted within 21 days of the decision date, please explain why:


IMPORTANT:
CLAIMANT - CONTINUE TO FILE: Please check the box below to acknowledge that you understand that you must continue to file claims pending a decision by the Referee on your appeal. If you fail to file a claim each week, as directed, no benefits can be paid for those weeks, irrespective of the decision of the Referee.


IMPORTANT:

PLEASE BE SURE TO PRINT A COPY OF THE DATA CONFIRMATION PAGE THAT WILL DISPLAY AFTER YOU SUBMIT THIS FORM. KEEP THIS COPY FOR YOUR RECORDS. YOUR COPY OF THE DATA CONFIRMATION PAGE VERIFIES THAT YOUR APPEAL HAS BEEN FILED AND RECEIVED FOR PROCESSING BY YOUR LOCAL AMERICAN JOB CENTER.


IN SUBMITTING THIS FORM, I HEREBY APPEAL FROM THE LOCAL AMERICAN JOB CENTER DECISION DENYING BENEFITS AND APPLY FOR A HEARING.




Please refer to A Claimant's Guide to the Appeals Process for more information about the unemployment compensation appeals process.

 

 


200 Folly Brook Boulevard, Wethersfield, CT 06109 / Phone: 860-263-6000

Home | 
CT.gov Home Send Feedback
State of Connecticut Disclaimer and Privacy Policy. Copyright 2002 - present year