CDLE Walk-Ins Claimant Form
Language:
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English
Spanish
First Name:
Last Name:
Phone Number:
CDLE Agent Name:
CID (if available):
Reason for the request:
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Filing new claim
Reopen/Additional job separation
Weekly certification
Other
By checking this box, I consent to CDLE to contact me at the number I provided, including by texts and calls made using an automatic telephone dialing system or prerecorded voice related to the service I asked about, regardless of my inclusion on any state, federal, or company-wide do-not-call lists. Consent is not a condition of purchase.