STATE OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT Division of Employment Security Appeals Operations 220 French Landing Drive Nashville, Tennessee 37243
Telephone: (615) 741-1857 Facsimile: (615) 741-8933
Request to Reschedule Hearing
Claimant's Social Security Number _____________________________
Docket Number ___________________________
Claimant's Name _________________________________
Employer's Name __________________________________
Street Address ___________________________________
Street Address ____________________________________
City ____________________ State ____
Zip __________
City ______________________ State ____ Zip _________
Claimant's Telephone ______________________________
Employer's Telephone ______________________________
Please reschedule the:
Appeals Tribunal
Board of Review
hearing currently set for
_______________________ (time)
on
_________________________ (date)
with
___________________________________________ (hearing officer)
I have a significant conflict with the date/time for the hearing. (Please describe) ____________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Date ________________________
Signature _____________________________________ Title __________________________________________ (if employer)
Note:
Absent an emergency, a party requesting a reschedule of an Appeals Tribunal hearing must make its request at least 48 hours before the date and time of the hearing.
LB-0896