This is the online form to request that your hearing on an Employment Security Department (ESD) decision be scheduled as soon as possible due to an urgent financial hardship. Date of Request Claimant Name First Name Last Name Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Email Phone You must give us an address, email or phone number in order to receive a response. Docket Number(s) Please describe your urgent financial hardship below. An urgent financial hardship is when you cannot meet your basic expenses to allow you to live, work, or seek work. Examples of financial hardship include being unable to pay for your housing, utilities, or transportation. You must click "I agree" below in order to attest to the truth of your statement under penalty of perjury. You should also submit documents (click for how to submit documents) that show your financial hardship, such as overdue bills for necessities (ex. rent, utilities) or notices of eviction or repossession. If you cannot provide documents, then please explain why. Your request is more likely to be denied if you do not provide documents or explain why you cannot provide them. Describe hardship here I hereby affirm under the penalties of perjury as detailed by RCW 9A.72 that my above statement is true to the best of my knowledge, information, and belief. I agree Submit Leave this field blank
