"Appeal Request" - Washington

Appeal Request is a legal document that was released by the Washington State Employment Security Department - a government authority operating within Washington.

Form Details:

  • The latest edition currently provided by the Washington State Employment Security Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Washington State Employment Security Department.

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Download "Appeal Request" - Washington

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APPEAL REQUEST
The easiest way to appeal is
online
in eServices (https://secure.esd.wa.gov/home/). Click on the Decisions status tab.
Or you may use this form to file an appeal if you’ve received a “Determination Letter” from us and you disagree with it. An appeal
cannot be filed until a determination has been made.
For instructions on filing an appeal, refer to the “Determination Letter.” You also can read more on our website (esd.wa.gov) under
Benefit denials and appeals and the
“Handbook for Unemployed
Workers.” Use the search box to find these items.
* Required Fields.
*Claimant SSN/ID#: _______________________
*First and last name: ________________________________________
*Current mailing address
: _________________________________________________
(if different from the “Determination Letter”)
_________________________________________________
Phone #: (_____) _________________
Email address: _____________________________________________________
*Letter ID # or Case #: ________________________
(See the “Determination Letter” for the Letter ID # or Case #)
One letter per appeal request
Employer name (if applicable): ________________________________________________________
 Interpreter needed
Preferred language: ________________________________________________
*Why do you disagree with the determinationintheletterIDindicatedabove?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
*Signature:_____________________________________________Wecan’tacceptyourappealwithout y oursignature.
Print this page andsubmit once by fax or mail to the address listed below with any additional information you wish to provide.
Visit your local WorkSource office if you need help faxing the appeal.
The Employment Security Department is an equal opportunity employer/programs. Auxiliary aids and services are available upon request to individuals with disabilities.
Language assistance services for limited English proficient individuals are available free of charge. Washington Relay Service: 711
1795
Claims Center Appeals, PO Box 19018 • Olympia, WA 98507-0018 • Fax 800-301-
APPEAL REQUEST
The easiest way to appeal is
online
in eServices (https://secure.esd.wa.gov/home/). Click on the Decisions status tab.
Or you may use this form to file an appeal if you’ve received a “Determination Letter” from us and you disagree with it. An appeal
cannot be filed until a determination has been made.
For instructions on filing an appeal, refer to the “Determination Letter.” You also can read more on our website (esd.wa.gov) under
Benefit denials and appeals and the
“Handbook for Unemployed
Workers.” Use the search box to find these items.
* Required Fields.
*Claimant SSN/ID#: _______________________
*First and last name: ________________________________________
*Current mailing address
: _________________________________________________
(if different from the “Determination Letter”)
_________________________________________________
Phone #: (_____) _________________
Email address: _____________________________________________________
*Letter ID # or Case #: ________________________
(See the “Determination Letter” for the Letter ID # or Case #)
One letter per appeal request
Employer name (if applicable): ________________________________________________________
 Interpreter needed
Preferred language: ________________________________________________
*Why do you disagree with the determinationintheletterIDindicatedabove?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
*Signature:_____________________________________________Wecan’tacceptyourappealwithout y oursignature.
Print this page andsubmit once by fax or mail to the address listed below with any additional information you wish to provide.
Visit your local WorkSource office if you need help faxing the appeal.
The Employment Security Department is an equal opportunity employer/programs. Auxiliary aids and services are available upon request to individuals with disabilities.
Language assistance services for limited English proficient individuals are available free of charge. Washington Relay Service: 711
1795
Claims Center Appeals, PO Box 19018 • Olympia, WA 98507-0018 • Fax 800-301-