INSTRUCTIONS FOR USERRA CLAIMS
VETS/USERRA/VP FORM 1010
PLEASE NOTE:
The Electronic 1010 Claim filing system might be inaccessible at times. If that website is unavailable for any reason, you may submit a hard copy Form
1010 instead. To do so, please send a hard copy 1010 form (by mail or fax) to:
Veterans' Employment and Training Service
U.S. Department of Labor
ATTENTION: Form 1010
61 Forsyth Street, S.W., Room 6T85
Atlanta, Georgia 30303
FAX: (404) 562-2313
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You may submit Form 1010 in either of two ways:
- Submitting a signed hard copy of Form 1010. You may download
Form 1010 to your computer, complete the items on the form that are
relevant to your claim, print the form, sign and date the form, and then either
mail it, or fax it, or deliver it in person, to the following VETS office
only:
Veterans' Employment and Training Service
U.S. Department of Labor ATTENTION: Form 1010 61 Forsyth Street, S.W., Room 6T85
Atlanta, Georgia 30303
FAX: (404) 562-2313
The Form 1010 information you
enter after download is not being saved or collected from this Internet site;
instead, you must print out the completed form and either mail it, or fax it, or
deliver it in person, to the VETS address shown above.
- Submitting Form 1010 electronically via the Internet. If you prefer
to file Form 1010 electronically via the Internet instead of mailing a printed
form, you can complete and submit the “On-line” version of Form 1010 at VETS
1010 Form On-line Submission website:
https://vets1010.dol.gov/ .
Please read the Privacy Act statement and certification on page two of Form
1010 before signing and submitting the form.
Below are some brief instructions on filling out Form 1010. However, if
questions arise that are not addressed here, please contact the
nearest VETS office for assistance.
SPECIFIC INSTRUCTIONS
NOTE: These instructions are for persons filing USERRA claims only. If you
are filing a Veterans' Preference complaint, please refer to the instructions in
the
Veterans' Preference Advisor.
Section I
Self-explanatory.
Section II
For this section please
use the branch of service that you were, are or will be in when the
allegations that lead you to file this complaint occurred. For each
question, answer to the best of your ability only the questions that apply
to you. This information must eventually be supported with documentation in
order for VETS to establish your eligibility under the law.
- Question 8 - Fill in the branch of service you that you
are, have been or will be a member of.
- Question 9 - Fill in the specific information you have of
your unit including name, address and phone number.
- Question 10 - Fill in the dates that you served in, the
date that you began your service, or the date that you will begin your
service.
- Question 11 - Fill in the appropriate bubble that best
describes how you were discharged.
Section III
Please report the
information of the employer(s) that your complaint involves. Do so
accurately because this information will be used to establish a point of
contact within the agency or company.
- Question 12 - Fill in the name of your employer or the
employer you are applying for.
- Question 13 - Fill in the address.
- Question 14 -
- Fill in the name and, if
possible, title of whoever you are or have been in contact with
regarding your position.
(Often a HR specialist or supervisor)
- Fill in their phone number
- Question 15 - Fill in the dates that you have been
employed with this employer, the date that you started working for this
employer, or the date you will start working for this employer.
- Question 16 - Fill in no if you have not exceeded five
cumulative years of uniformed service with this employer. Answer yes, and
explain in the comment section below, if you have.
- Question 17 - Fill in the name of any Union(s) that may
represent you.
- Question 18 - Fill in the title of the position you have,
had or are applying to.
Section IV
Please use this section
to detail some specifics of your complaint. Answer each question that
applies to you as completely and accurately as you can.
- Question 19 - Fill in yes if the Employer Support of the
Guard and Reserve (ESGR) was involved in your claim before filing this
complaint.
- Leave Question 20 blank. Question 20 is for Veterans'
Preference complaints only.
If Claim Concerns Discrimination under
USERRA
- Question 21
- If you feel that your past, present or
future military obligations were used to discriminate you by your employer;
please fill in the issue that best describes your complaint.
If Claim Concerns Hiring, RIF, Promotion or
Termination
- Question 22
- Fill in the title of the position that
relates to this complaint.
- Question 23 - Fill in the pay rate for the position you
had, have or were applying for.
- Question 24
- Fill in the date you applied for the job or
promotion. (Often found on the job certificate, posting)
- Fill in the vacancy
announcement number
- Fill in the date the
vacancy opened
- Fill in the date the
vacancy closed
If Claim Concerns Reemployment Following
Service
- Question 25
- Fill in yes if you provided notice of your
service to your employer before you began your military service.
- Question 26 - Specify who provided this notice.
- Specify how it was
provided.
- Fill in the date that this
notice was provided.
- Question 27
- Fill in the name of who you provided this
notice to.
- Question 28 - Fill in the date you applied for
reemployment with your employer or the date you returned to work with your
employer-whichever applies to you.
- Question 29
- Fill in the name and title of the person who
you applied for reemployment with.
- Question 30 - Fill in yes and the date if you are
reemployed or have been reinstated with your employer.
- If yes, fill in your
position and pay rate.
- If no, fill in the date
that your reemployment was denied and state the reason that was given.
- Fill in the name of
who within your employer denied your reemployment.
Comments
Please write clearly and
coherently why you are filing this claim. Detail what remedies (e.g.,
employment, reemployment rights, lost wages, seniority benefits) you seek by
filing this claim.
Please return to the Previous Page.
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