MMBA Representation Petition Form. This is a California form and can be use in Public Employment Relations Board (PERB) Statewide.
Tags: MMBA Representation Petition, PERB-6110, California Statewide, Public Employment Relations Board (PERB)
(818)551-2822 Sacramento Regional Office 1031 18th Street Sacramento, CA 95811-4124 (916)322-3198San Francisco Regional Office 1330 Broadway, Suite 1532 Oakland, CA 94612-2514 (510)622-1016 PERB-60 (/1) MMBA REPRESENTATION PETITION DO NOT WRITE IN THIS SPACE: Case No.: Dated Filed: INSTRUCTIONS: A request for recognition or petition for certification may be filed with the appropriate PERB regional office, unless the employer has adopted local rules providing for an equivalent procedure. Proper filing includes concurrent service and proof of service of the MMBA Representation Petition as required by PERB Regulations 61210 et seq. Attach additional sheets if more space is required. 1.EMPLOYER (Name, address and telephone number)Name: Address: City, State, Zip: Telephone: ()Ext. Employer222s agent to be contacted: Title: Address and telephone, if different: Address: City, State Zip: Telephone: ()Ext. E-Mail: 2.TYPE OF PETITION (Check all that apply) REQUEST FOR RECOGNITION (RR) PETITION FOR CERTIFICATION (PC) SEVERANCE (Filed as PC) SEVERANCE (Filed as RR)3.PROOF OF SUPPORT Majority support 30% support 4.DESCRIPTION OF PROPOSED UNIT5.NUMBER OF EMPLOYEES IN PROPOSED UNIT: Shall INCLUDE: Shall EXCLUDE: 6.IF A CURRENT MEMORANDUM OF UNDERSTANDING(MOU) EXISTS COVERING ANY EMPLOYEES PETITIONEDFOR, INDICATE: MOU EFFECTIVE DATE: MOU EXPIRATION DATE: NO AGREEMENT IS IN EFFECT 7.ORGANIZATION(S) RECOGNIZED OR CERTIFIED AS THE EXCLUSIVE REPRESENTATIVE OF OR KNOWN TO HAVE AN INTERESTIN REPRESENTING ANY OF THE EMPLOYEES COVERED BY THIS PETITION: Date of Recognition/ Name of Organization AddressCertification (if any) 8.PETITIONER (Name, address and telephone number)Address:City, State Zip: Telephone: ()Ext. Petitioner222s agent to be contacted: Title: Address and telephone, if different: Address: City, State Zip: Telephone: ()Ext. E-Mail: DECLARATION I declare that the statements herein are true to the best of my knowledge and belief. PETITIONER222S AUTHORIZED REPRESENTATIVE: (Signature) Title:Date: American LegalNet, Inc. www.FormsWorkFlow.com PERB-6 (/1) NOTICE OF MMBA REPRESENTATION PETITION PERB CASE NUMBER: DATE NOTICE WAS POSTED: ON , THE PETITION INDICATED BELOW WAS FILED WITH THE (DATE) PUBLIC EMPLOYMENT RELATIONS BOARD BY THE PETITIONER SHOWN ON THE . PETITION FOR CERTIFICATION REQUEST FOR RECOGNITION SEVERANCE REQUEST THE PETITION IS BASED ON THE CLAIM THAT (CHECK ONE) A MAJORITY AT LEAST 30% OF THE EMPLOYEES IN THE PROPOSED UNIT WISH TO BE REPRESENTED BY THE PETITIONER. SEE THE FOR THE NAMES, ADDRESSES AND TELEPHONE NUMBERS OF THE EMPLOYER, THE INCUMBENT EXCLUSIVE REPRESENTATIVE (IF ANY), AND THE PETITIONER. THIS NOTICE MUST REMAIN POSTED UNTIL: BY (SIGNATURE OF EMPLOYER222S AUTHORIZED AGENT) PERB Regulation 61220 requires that this Notice be conspicuously posted on all employee bulletin boards in each facility of the employer in which members of the proposed unit are employed. The Notice should be posted as soon as possible but in no event later than 10 days following receipt of the petition. The Notice must remain posted for at least 15 workdays. American LegalNet, Inc. www.FormsWorkFlow.com