VETS/USERRA/VP FORM 1010
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
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 St SW
Atlanta, GA 30303
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.
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.
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.
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
- Fill in the name and, if possible, title of whoever you are or have been in contact with regarding your position.
- 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.
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.
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.
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