USERRA Complaint (VETS Form 1010)
COMPLAINT UNDER THE UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) 1. CLAIMANT INFORMATION: Name: {veteran_name} Address: {address} Phone: {phone} Email: {email} 2. EMPLOYER INFORMATION: Employer Name: {employer_name} Em…
Fields
- veteran_name
- employer_name
- type_of_service
- violation_description
- dates
- witnesses
Template
COMPLAINT UNDER THE UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA)
1. CLAIMANT INFORMATION:
Name: {veteran_name}
Address: {address}
Phone: {phone}
Email: {email}
2. EMPLOYER INFORMATION:
Employer Name: {employer_name}
Employer Address: {employer_address}
Supervisor: {supervisor_name}
3. MILITARY SERVICE:
Branch: {branch}
Component: {component}
Type of Duty: {type_of_service}
Orders Dates: {service_dates}
4. VIOLATION DESCRIPTION:
Type of Violation: {violation_type}
Date(s) of Violation: {violation_dates}
Description:
{violation_description}
5. NOTICE PROVIDED TO EMPLOYER:
{notice_description}
6. WITNESSES:
{witnesses}
7. RESOLUTION SOUGHT:
{requested_relief}
I certify that the above information is true and correct to the best of my knowledge.
Signature: ___________________
Date: {date}