Employer Protest of Benefit Charge
Please complete all fields below and complete the Refusal of Work Questionnaire if appropriate, then click "Submit". You will receive a confirmation number which you should retain for your records. All protests will be addressed in the order in which they are received.
Please do not submit duplicate requests for the same employee.
Employer Registration Number (ERN):
(ERN: (10 Digits. Ex: 0012345678))
Company Contact Person:
Contact Person's Title:
Employee's First Name:
Employee's Last Name:
Last 4 digits of employee's Social Security Number:
Reason For Protest:
Fraudulent Charges – employee never unemployed (ID Theft)
Voluntary Quit Without Good Cause
Refusal Of Work
Valid Termination For Cause
Monthly Charge Statement Month/Year Protested:
Employee's Last Day of Work:
"I certify under penalties of perjury that I am an authorized representative of the employer and that the information provided in this request for reconsideration of charges is true and correct to the best of my knowledge."
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