Request for USERRA-Eligible Service Form - state nj 2026

1. Click ‘Get Form’ to open the Request for USERRA-Eligible Service Form in the editor.
2. Begin by filling out the Employee Section. Enter your name, address, membership number, and social security number in the designated fields.
3. Indicate the date you left public employment for uniformed service by selecting the month, day, and year from the dropdown menus.
4. Provide the name of your former employer and specify the dates of your uniformed service. Attach any supporting documentation such as military orders if necessary.
5. In the Employer Certification section, ensure that your employer fills in their name and certifies your eligibility by providing their signature and date of return to public employment.
6. Lastly, confirm pensionable salary details during your military service period. If not determinable, check the appropriate box for salary determination by the Division.

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