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Once an employee returns to work with his or her pre-military leave of absence employer, the employer is required to submit this form along with a copy of the appropriate military paperwork.

If you would like to complete the form electronically, be sure to first download the form, complete using Acrobat Reader, and save. Note: ETF is unable to assist with Adobe Acrobat Reader technical or compatibility issues. If you need assistance, please visit Adobe’s help site at

Submit the completed form to your employer.