Request for USERRA-Eligible Service Form - state nj 2026

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The document is a request form for USERRA-eligible service, allowing public employees to claim pension benefits under the Uniformed Services Employment and Reemployment Rights Act of 1994. It includes sections for employee information, employer certification, and details regarding military service dates and pensionable salary.

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Click ‘Get Form’ to open the Request for USERRA-Eligible Service Form in the editor.
Begin by filling out the Employee Section. Enter your name, address, membership number, and social security number in the designated fields.
Indicate the date you left public employment for uniformed service by selecting the month, day, and year from the dropdown menus.
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.
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.
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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How do I file a claim with USERRA?

If you believe your rights under USERRA have been violated by your employer, you can call 1-800-336-4590 (option one) between 8am and 6pm Eastern Standard Time to speak with an ESGR representative or you may fill out the form below. An ESGR representative will contact you.

How do you qualify for USERRA?

To qualify for USERRAs protections, a service member must be available to return to work within certain time limits. These time limits for returning to work depend (with the exception of fitness-for-service examinations) on the duration of a persons military service.

What are the rules for employers for USERRA?

There should be no waiting periods other than those required due to service-related illnesses or injuries. USERRA protects employees from discrimination due to military service.

Who is eligible for PERS NJ?

Public Employee Retirement System (PERS) The Public Employees Retirement System is open to state, county, municipal, authority, and school board employees who are precluded from any other NJ state pension system (e.g., Teachers, Police and Fire, State Police, Judicial).

Does USERRA apply to State National Guard?

116-315 Veterans Health Care and Improvement Act National Guard members on State Active Duty are covered by USERRA when they meet ANY of the following criteria: a.) Serving for a period of 14 days or more, or b.) in support of a national emergency declared by the President under the National Emergencies Act, or c.)

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