To file a petition for review electronically, complete this form and follow the filing instructions below. Fields marked with an asterisk (*) are mandatory and must be completed.
PLEASE NOTE: This form may NOT be used to appeal an Initial Determination. It may ONLY be used to appeal an Administrative Law Judge's Appeal Tribunal Decision.
I hereby petition for review by the Labor and Industry Review Commission of the ALJ's decision in the following Unemployment Insurance matter:
(Instructions are shown to the right of each form field)