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:
If this appeal is not transmitted within 21 days of the decision date,
please explain why:
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
200 Folly Brook Boulevard, Wethersfield, CT 06109 / Phone: 860-263-6000
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