Wisconsin Labor and Industry Review Commission

Form For Electronic Filing of Petition for Commission Review (Unemployment Insurance)


To file a petition for review electronically, complete this form and follow the filing instructions below. Fields marked with an asterisk (*) are mandatory and must be completed.

PLEASE NOTE: This form may NOT be used to appeal an Initial Determination. It may ONLY be used to appeal an Administrative Law Judge's Appeal Tribunal Decision.


I hereby petition for review by the Labor and Industry Review Commission of the ALJ's decision in the following Unemployment Insurance matter:

(Instructions are shown to the right of each form field)


Petition Information:

Enter the hearing number(s) shown on the first page of the Appeal Tribunal Decision.

Enter the date shown in the "Dated and Mailed" box on the first page of the Appeal Tribunal Decision.

If this petition is not being filed by the date in the "Appeal Deadline" box on the Appeal Tribunal Decision, provide a specific and complete explanation why here.

Enter the name of the employee shown on the first page of the Appeal Tribunal Decision (if no employee name is shown on the ATD, this box may be left blank).

Enter the name of the employer shown on the first page of the Appeal Tribunal Decision (if no employer name is shown on the ATD, this box may be left blank).

A statement of the reasons this petition is being filed may be entered here. (Optional)


Information about the person filing this petition:

The person filing this petition should enter his or her name here, and indicate if he or she is the employee or the employer, an attorney or representative of the employee or the employer, or if this is a petition by the department.

I am the:






The person filing this petition should enter his or her mailing address here.

The person filing this petition should enter his or her city here.

The person filing this petition should enter his or her state here.

The person filing this petition should enter his or her zip code here.

(Optional)

A confirmation message will be sent to any e-mail address entered here. (Optional)


Filing instructions:



LIR-15356-E (R.10/2010)