App-100 Notice of Appeal to Appeal Tribunal - South Carolina
APP-100 NET…Rev. 7/13
Catalog#: 05082
SOUTH CAROLINA DEPARTMENT OF EMPLOYMENT AND WORKFORCE
P. O. Box 995, Columbia, South Carolina 29202
Notice of Appeal to Appeal Tribunal
Claimant’s Name: Social Security Number: - -
Claimant’s Address:
Telephone:
Employer’s Name: Telephone:
Employer’s Address:
Please refer to Determination by Claims Adjudicator to complete section below.
On I received the determination mailed .
(Date of receipt) (Mailing date on Notice)
I appeal and hereby apply for a hearing because I believe it was issued in error for the following reasons:
If appeal is untimely or you were absent from a prior hearing, state the reason:
I must continue to file my claim for each week of unemployment until I receive the Appeal Tribunal or Appellate Panel decision, until I return to work, or until my claim is exhausted. If I win the appeal, I know I can only be paid for those weeks that I have timely claimed.
(Claimant’s Initials)
Does claimant need an interpreter? YES NO What language/dialect? Claimant is Deaf Mute
(If it appears necessary to subpoena witnesses or documents, please complete Form APP-107 and attach it when you submit your appeal.)
SUBPOENA YES NO Who is filing appeal: Claimant Employer
Signature:
Title: Date:
Please submit form by fax to 803.737.0287 or by mail to: “Appeal Tribunal, P.O. Box 995, Columbia, SC 29202.”
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