Employer's Motion to Reopen a Referee's Decision

Employer's Motion to Reopen a Referee's Decision

State of Connecticut, Department of Labor, Employment Security Appeals Division
NOTES

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

"*" indicates a required field.
Case Information
Party Filing Motion
Do not attempt to fill in this field. For office use only.
Date of Referee Decision

MonthDayYear
Docket Number*
Enter the 6-digit or 8-digit number at the top right corner of your hearing notice or Adjudications decision letter.

Employer Information
Employer Registration or Identification Number*
Enter the 10 digits of your Employer Registration or Identification Number.
Employer Name*
Employer Address*

Street Address

Street Address Line 2

StateCity/Town

Postal / Zip Code
Contact Name*
Contact Title*
Employer Phone Number*

Area CodePhone Number

Other Parties - Employer Agents
Do you have an attorney or agent working with you on this motion?*

YesNo
You have indicated that you have an attorney or agent working with you on this motion. Will this attorney or agent be submitting this motion on your behalf?*

Yes, an attorney or agent will be submitting this motion on my behalf.No, I have an attorney or agent working with me on this motion, but I will be submitting it myself.
You have indicated that you have an attorney or agent working with you to submit this motion to reopen the Referee's decision on your behalf. Please have your attorney or agent answer the questions below.
Employer Agent Information
Employer Agent Name*

First NameLast Name
Employer Agent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Other Parties - Claimants
Did the Adjudicator's decision involve a claimant?

YesNo
You have indicated that the Adjudicator's decision involved a claimant. Please answer the questions below.
Claimant Information
Which of the following issues pertain(s) to this motion? *
Select an option from the menu above.
Please explain this issue in more detail. *
Enter your response in the space above.
Claimant Social Security Number*
Enter the 9 digits of the claimant's Social Security Number (SSN).
Claimant Name*

First NameLast Name
Claimant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employer Questions
Use the space below to enter the reason(s) why you move to reopen the Referee's decision. *
Enter your response in the space above.
Did you attend the Referee's hearing?*

YesNo
You have indicated that you did not attend the Referee's hearing. Are you requesting a new hearing?*

YesNo
You have indicated that you did not attend the Referee's hearing and are requesting a new hearing. Please use the space below to explain in detail your reasons for (1) failing to appear and (2) failing to request a postponement (if appropriate).*
Enter your response in the space above.
Was this motion transmitted within 21 days of the decision date?*

YesNo
You have indicated that this motion was not transmitted within 21 days of the decision date. Please use the space below to explain why.*
Enter your response in the space above.

Employer - Submit Your Motion
Please verify that you are human.*
For verification purposes, please trace the image presented:*
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.

IN SUBMITTING THIS FORM, I HEREBY MOVE TO REOPEN THE REFEREE'S DECISION.
Should be Empty:

Case Information