SHOWING OF INTEREST I am employed by the (PRINT NAME OF EMPLOYER) and I sign this showing of interest in support of a representation petition to be filed by (PRINT NAME OF PETITIONER) with the New York State Public Employment Relations Board to certify the petitioner and/or to decertify the current negotiating agent with respect to the following negotiating unit: (List Job Titles In Current or Proposed Bargaining Unit) ___________________________________________ 1. FULL NAME (Print): ___________________________________________________________ ADDRESS: __________________________________________________________________ TITLE: _____________________________________________________________________ WORK LOCATION: ___________________________________________________________ FULL SIGNATURE: __________________________________ DATE:___________________ 2. FULL NAME (Print): ___________________________________________________________ ADDRESS: __________________________________________________________________ TITLE: _____________________________________________________________________ WORK LOCATION: ___________________________________________________________ FULL SIGNATURE: _________________________________ DATE:___________________ 3. FULL NAME (Print): ___________________________________________________________ ADDRESS: __________________________________________________________________ TITLE: _____________________________________________________________________ WORK LOCATION: ___________________________________________________________ FULL SIGNATURE:__________________________________ DATE:___________________ 4. FULL NAME (Print): ___________________________________________________________ ADDRESS: __________________________________________________________________ TITLE: _____________________________________________________________________ WORK LOCATION: ___________________________________________________________ FULL SIGNATURE: _________________________________ DATE:___________________ 5. FULL NAME (Print): ___________________________________________________________ ADDRESS: __________________________________________________________________ TITLE: _____________________________________________________________________ WORK LOCATION: ___________________________________________________________ FULL SIGNATURE: _________________________________ DATE:___________________ Page_____of_____ American LegalNet, Inc. www.USCourtForms.com