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: _____________________________________________________
Employer name (if applicable): ________________________________________________________
*Letter ID # or Case #: ________________________
(See the “Determination Letter” for the Letter ID # or Case #)
One letter per appeal request
Interpreter needed Preferred language: ________________________________________________
APPEAL REQUEST
*Why do you disagree with the determinationintheletterIDindicatedabove?
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*Signature:_____________________________________________Wecan’tacceptyourappealwithoutyoursignature.
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
Claims Center Appeals, PO Box 19018 • Olympia, WA 98507-0018 • Fax 800-301-1795
