Fill and Sign the Sba 7a Loan Application Fillable Form

Oregon Employment Department Appeals Board Application For Review 1. I disagree with the hearing decision mailed on _____________________________. I request a review by the Employment Appeals Board. 2. The case number of the hearing decision is _________________________________________________. 3. My name is (please print) _______________________________________________________________. 4. My address is ________________________________________________________________________. 5. I am the: Claimant  Employer  or, if applicable: I am the authorized representative for _____________________________________________________. My name is (please print) _______________________________________________________________. My address is ________________________________________________________________________. I can be contacted by e-mail (provide address): ____________________________________________________________________________________. Important Information: I understand that filing an application for review will not mean that I get a new hearing. The Employment Appeals Board will review a transcript of the testimony, and any exhibits that were made part of the record, and issue a written decision. The Employment Appeals Board will NOT accept new information related to my case unless I can show that factors or circumstances beyond my reasonable control prevented me from presenting the information at the time of the hearing. For additional information visit: www.oregon.gov/EMPLOY/EAB Signature: ________________________________________ Date: ______________________________ This application may be delivered to any office of the Employment Department or mailed to: Employment Appeals Board, 875 Union St. NE, Salem, OR 97311 or Fax: (503) 378-2129. WorkSource Oregon Employment Department is an equal opportunity employer/program. Auxiliary aids and services, alternate formats and language services are available to individuals with disabilities and limited English proficiency free of cost upon request. WorkSource Oregon Departamento de Empleo es un programa que respeta la igualdad de oportunidades. Disponemos de servicios o ayudas auxiliares, formatos alternos y asistencia de idiomas para personas con discapacidades o conocimiento limitado del inglés, a pedido y sin costo. WorkSource Oregon Employment Department • www.WorkingInOregon.org • FORM 363 (0909)