New Jersey USERRA Eligible Service Request 2026

1. Click ‘Get Form’ to open the Request for USERRA–Eligible Service form in our editor.
2. Begin by filling out Part 1 — Member Information. Enter your name, address, membership number, and social security number in the designated fields.
3. Provide the date you left public employment for uniformed service and the name of your former employer. Ensure to include the dates of your uniformed service and attach any supporting documentation as required.
4. In Part 2 — Employer Certification, have your employer’s certifying officer complete their section. They will need to enter the employer's name, date of return to public employment, and pensionable salary information.
5. The certifying officer must sign and date the form, confirming eligibility for pension benefits under USERRA.

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