PLRB-13 (Rev. 10/84) COMMONWEALTH OF PENNSYLVANIA Pennsylvania Labor Relations Board PETITION IN THE MATTER OF THE EMPLOYES OF DO NOT WRITE IN THIS SPACE Case No. Date Filed ABOVE IS FOR PLRB USE ONLY 1. Purpose of this Petition: (Check One) - (File Original and Three (3) Copies) PETITION FOR REPRESENTATION (Private Sector (PLRA) or Police/Fire (Act 111)) Petitioner seeks investigation of a question of representation and certification of representative designated or selected for the purpose of collective bargaining by the employes in an appropriate unit. SIGNED AND DATED SHOWING OF INTEREST MUST BE ATTACHED HERETO. (Refer to Section 7(c) PLRA and 34 Pa. Code Sections 91.1 et seq.) JOINT REQUEST FOR CERTIFICATION (Private Sector (PLRA) or Police/Fire (Act 111)) The employer recognizes the employe representative and agrees that the unit set forth below (paragraph 4) is appropriate and that the employe representative has the necessary support from the employes as required by law. EMPLOYER AND EMPLOYE ORGANIZATION MUST SIGN THIS REQUEST. JOINT REQUEST MUST BE POSTED FOR A PERIOD OF 5 DAYS IN WORK LOCATIONS OF EMPLOYES IN THE BARGAINING UNIT BEFORE IT IS FILED WITH THE BOARD. PETITION FOR DECERTIFICATION (Private Sector (PLRA) or Police/Fire (Act 111)) Thirty (30) percent or more of the employes assert that the bargaining representative is no longer their representative or the employer alleges a good faith doubt of the majority status of the present representative. SIGNED AND DATED SHOWING OF INTEREST BY EMPLOYES OR FACTUAL STATEMENT INDICATING EMPLOYER'S GOOD FAITH DOUBT MUST BE ATTACHED HERETO. PETITION FOR UNIT CLARIFICATION (Private Sector (PLRA) or Police/Fire (Act 111)) An employe organization is currently recognized by the employer, and petitioner seeks clarification of existing unit. (Unit certified in Case No. if applicable.) PETITION FOR AMENDMENT OF CERTIFICATION (Private Sector (PLRA or Police/Fire (Act 111)) - Petitioner seeks amendment of certification issued in Case No. ATTACH STATEMENT DESCRIBING THE SPECIFIC AMENDMENT SOUGHT. 2. NAME OF EMPLOYER Representative to Contact: ADDRESS: (Street, Number, City, State, ZIP) Telephone Number: 3. NAME OF EMPLOYE ORGANIZATION ADDRESS: (Street, Number, City, State, ZIP) Telephone Number: American LegalNet, Inc. www.FormsWorkflow.com 4. Description of unit deemed to be appropriate (in Petitions for Unit Clarification, describe PRESENT unit below and attach description of proposed clarification and reasons for the request). INCLUDED: EXCLUDED: 5. Approximate number of employes in the unit claimed to be appropriate: (For UC Petitions, indicate number of employes in present unit and number of employes proposed to be added/deleted) 6. There are no other employe representatives claiming to represent any of the employes in the proposed bargaining unit except (Name, Address, Telephone Number, or write NONE) 7. Date of expiration of current agreement, if any: (Day, Year, or write NONE) 8. Other relevant facts should be set forth on an additional sheet. I declare that I have read the above petition and that the statements therein are true to the best of my knowledge and belief. Petitioner(s) and affiliation, if any: signed and printed name(s) of representative(s) or person(s) filing Petition: BY (Title, if any) BY (Title, if any) ADDRESS(ES) (Street & Number) (City, State & ZIP) PHONE NUMBER (Street & Number (City, State & ZIP) PHONE NUMBER (INCOMPLETE OR INACCURATE STATEMENTS HEREON MAY RESULT IN A DISMISSAL OF THIS PETITION) American LegalNet, Inc. www.FormsWorkflow.com