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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.

Submit the completed form to your employer.

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