PERB STATE OF NEW YORK PUBLIC EMPLOYMENT RELATIONS BOARD PETITION TO REVIEW THE IMPLEMENTATION OF LOCAL GOVERNMENT PROVISIONS AND PROCEDURES PURSUANT TO SECTION 212 OF THE CIVIL SERVICE LAW AND PERB RULE 203.8 DO NOT WRITE IN THIS SPACE INSTRUCTIONS: File the original and three copies Case No. Iof this petition with the Office of the Counsel, Public Employment Relations Board, PO BOX 2074, Date Received: ESP AGENCY BLDG 2, FLS 18 & 20, ALBANY, NY 12220-0074. If you need more space for any item, attach additional sheets and number the item the same as on this form. The undersigned Petitioner hereby alleges that the continuing implementation of the provisions and procedures of the local government indicated below are not substantially equivalent to the provisions and procedures set forth in Article 14 of the Civil Service Law and the Rules of Procedure of the Public Employment Relations Board. _ 1. NAME OF PETITIONER: ADDRESS: 2. NAME OF PETITIONER'S EMPLOYEE ORGANIZATION, IF ANY: ADDRESS: 3. NAME OF LOCAL GOVERNMENT: ADDRESS: 4. The names and addresses of the employee organizations, if any, that are certified or recognized to represent any public employees under the local government provisions and procedures: YOU MUST COMPLETE BOTH SIDES OF THIS FORM. American LegalNet, Inc. www.FormsWorkFlow.com 5. The names and addresses of other employee organizations, if any, that claim to represent any public employees under the jurisdiction of the local government: 6. Give a clear and concise statement of the facts upon which you allege that the local government provisions and procedures, as implemented, are not substantially equivalent to the provisions and procedures set forth in Article 14 of the Civil Service Law or the Rules of Procedure of the Public Employment Relations Board: I declare that I have read the above Petition and that the statements made are true to the best of my knowledge and belief. Dated: Signature of Petitioner Title, if any Telephone No. PERB 11 (9/08) American LegalNet, Inc. www.FormsWorkFlow.com