Form For Certification For Unemployed Veteran With Recent Military Service
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1Mail Completed Applications and DD Form 214 to:
Office of Veterans Affairs, 118 State Street, Montpelier, VT 05620-4401
Toll-free: (888) 666-9844; Phone: (802) 828-3379; Fax: (802) 828-5932
Operating Hours: Monday – Friday, 7:30 a.m. – 4:00 p.m.
CERTIFICATION FOR
UNEMPLOYED VETERAN WITH RECENT MILITARY SERVICE
In accordance with Act 44 of 2011, employers who hire a recently separated veteran may be eligible to receive
a tax credit of $2,000. Veterans who start their own business may receive up to a $2,000 tax credit.
Instructions and important eligibility information is attached.
To ensure fast and accurate processing, applicants should include a copy of their most recent DD Form 214.
APPLICANT INFORMATION (PLEASE PRINT LEGIBLY)
(Print) First Name:
Middle Initial:
Last Name:
Date of Birth:
Social Security Number:
Phone:
Email Address:
Mailing Address:
Town:
County:
State:
Zip:
Signature:
Date:
STAFF PROCESSING (VERMONT OFFICE OF VETERAN AFFAIRS STAFF ONLY)
The applicant above meets the military service
requirements for this program.
Yes
No
Authorized VOVA Signature:___________________
Printed Name:________________________________
Eligibility Expires:____________________________
Application not valid without Office of Veterans
Affairs stamp
STAFF PROCESSING (VERMONT DEPARTMENT OF LABOR STAFF ONLY)
The applicant above meets the criteria relating to the
Unemployment provisions for this program.
Yes
No
Authorized VDOL Signature:____________________
Application not valid without Vermont Department of
Printed Name:________________________________
Labor date stamp
State of Vermont, Office of Veterans Affairs Form 44. Printed June 13, 2011.
For more information on the benefits and services available to veterans and their dependents in Vermont, visit:
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