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RD Petition Form. This is a Official Federal Forms form and can be use in National Labor Relations Board.
Tags: RD Petition, NLRB-502 (RD), Official Federal Forms National Labor Relations Board,
INSTRUCTIONS: Unless e-Filed using the Agency's website, , submit an original of this Petition to an NLRB office in the Region in which the employer concerned is located. The petition must be accompanied by both a showing of interest (see 7 below) and a certificate of service showing service on the employer and all other parties named in the petition of:(1) the petition; (2) Statement of Position form (Form NLRB-505); and (3) Description of Representation Case Procedures (Form NLRB 4812). The showing of interest should only be filed with the NLRB and should not be served on the employer or any other party. 11a. Is there now a strike or picketing at the Employer's establishment(s) involved?UNITED STATES OF AMERICA NATIONAL LABOR RELATIONS BOARD DO NOT WRITE IN THIS SPACE (Street and number, city, state, ZIP code)WILLFUL FALSE STATEMENTS ON THIS PETITION CAN BE PUNISHED BY FINE AND IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001) PRIVACY ACT STATEMENT Solicitation of the information on this form is authorized by the National Labor Relations Act (NLRA), 29 U.S.C. § 151 et seq. The principal use of the information is to assist the National Labor Relations Board (NLRB) in processing representation and related proceedings or litigation. The routine uses for the information are fully set forth in the Federal Register, 71 Fed. Reg. 74942-43 (Dec. 13, 2006). The NLRB will further explain these uses upon request. Disclosure of this information to the NLRB is voluntary; however, failure to supply the information may cause the NLRB to decline to invoke its processes. - Name and Title 3b. Address (If same as 2b - state same) 3f. E-Mail Address 4a. Type of Establishment (Factory, mine, wholesaler, etc.) 4b. Principal product or service 5a. Description of Unit Involved 5b. City and State where unit is located: 6. No. of Employees in Unit 7. Do a substantial number (30% or more) of the employees in the unit no longer wish to be represented by the certified or currently recognized bargaining representative? No Yes 8a. Name of Recognized or Certified Bargaining Agent 8b. Affiliation, if any 8g. E-Mail Address 9. Date of Recognition or Certification 10. Expiration Date of Current or Most Recent Contract, if any (Month, Day, Year) No Yes 11b. If so, approximately how many employees are participating? 12f. E-Mail Address (Street and number, city, state, ZIP code) 15g. E-Mail Address I declare that I have read the above petition and that the statements are true to the best of my knowledge and belief. 15. Representative of the Petitioner who will accept service of all papers for purposes of the representation proceeding. 13b. Election Date(s) 13c. Election Time(s) 13d. Election Location(s) 13. Election Details: If the NLRB conducts an election in this 13a. Election Type: Mail Manual Mixed Manual/Mail (Street and number, city, state, ZIP code) 14e. E-Mail Address 12. Organizations or individuals other those named in items 8 and 11c, which have claimed recognition as representatives and other organizations and individuals known to have a representative interest in any employees in the unit described in item 5 above. (If none, so state)11c. The Employer has been picketed by or on behalf of www.nlrb.gov/