STATE OF CALIFORNIA Public Employment Relations Board Statement of Submission to Jurisdiction for Purposes of the Higher Education Employer-Employee Relations Act Instructions: Pursuant to the Higher Education Employer-Employee Relations Act (HEERA) (California Government Code section 3560 et seq.), any organization that represents one or more HEERA-covered employees whose principal worksite is located outside the State of California must file this statement with the California Public Employment Relations Board (PERB) in order to qualify as an 223employee organization224 within the meaning of HEERA. Statements relating to the University of California or Hastings College of Law must be filed with PERB222s San Francisco Regional Office. Statements relating to the California State University must be filed with the Los Angeles Regional Office. Service of the statement must be concurrently made on the appropriate higher education employer, and proof of service must be submitted to PERB. Statements, once filed, remain valid unless revoked or withdrawn by the filing organization. The employee organization identified below, in consideration of obtaining the benefits of status as an employee organization pursuant to the Higher Education Employer-Employee Relations Act (California Government Code section 3560 et seq.), hereby agrees to submit to the jurisdiction of the California Public Employment Relations Board. Employee Organization: Name: Address: City: State: () Optional: Authorized Agent: Name: Title: Address and telephone, if different: () The employer of the employees represented by the employee organization is the California State University Hastings College of the Law University of California and the employees involved are employed at (Name of Worksite) located in . (City/State) (Signature of Authorized Representative) (Date) San Francisco Regional Office 1330 Broadway, Suite 1532Oakland, CA 94612-2514(510)652-1016 American LegalNet, Inc. www.FormsWorkFlow.com