PETITION UNDER THE PUBLIC EMPLOYE RELATIONS ACT DO NOT WRITE IN THIS SPACE IN THE MATTER OF THE EMPLOYES OF: CASE NO. DATE FILED PETITION FOR REPRESENTATION – Thirty (30) percent or more of the employes wish to be represented by Petitioner and Petitioner desires to be certified as representative of the employes; SIGNED AND DATED SHOWING OF INTEREST MUST BE ATTACHED (refer to § 603(c) of the Public Employe Relations Act (Act) and 34 Pa. Code §§ 95.12 and 95.14). PETITION FOR DECERTIFICATION – Thirty (30) percent or more of the employes assert that the certified bargaining representative is no longer their representative (SIGNED AND DATED SHOWING OF INTEREST MUST BE ATTACHED) or the public employer alleges a good faith doubt of the majority status of the present representative; (FACTUAL SUPPORT MUST BE ATTACHED) (refer to § 607 of the Act and 34 Pa. Code §§ 95.21 and 95.22). PETITION FOR ELECTION BY PUBLIC EMPLOYER –A public employe, group of public employes, or employe organization has presented a claim to the public employer to be recognized as the representative of the employes of the public employer and thereafter has not sought an election (refer to § 603(d) of the Act and 34 Pa. Code § 95.14). PETITION FOR UNIT CLARIFICATION – An employe organization is currently recognized by the public employer, but Petitioner seeks clarification of the unit previously certified in Case No. ______________________________ (refer to 34 Pa. Code § 95.23). PETITION FOR AMENDMENT OF CERTIFICATION – Petitioner seeks amendment of certification issued in Case No.___________________________; STATEMENT DESCRIBING THE SPECIFIC AMENDMENT SOUGHT MUST BE ATTACHED (refer to 34 Pa. Code § 95.23). PUBLIC EMPLOYER INFORMATION ________________________________________________________________________________________________________________________ Public Employer Contact Name ________________________________________________________________________________________________________________________ Address ________________________________________________________________________________________________________________________ City State Zip Telephone EMPLOYE ORGANIZATION INFORMATION ________________________________________________________________________________________________________________________ Employe Organization Contact Name ________________________________________________________________________________________________________________________ Address ________________________________________________________________________________________________________________________ City 1. State Zip Telephone Description of the unit deemed to be appropriate (for Unit Clarification Petitions, describe present unit below and attach description of proposed clarification and reason(s) for the request): Included: Excluded: 2. Approximate number of employes in the unit claimed to be appropriate: Present: _____ PERA-4 REV 5-09 (Page 1) Proposed by Unit Clarification Petition: _____ American LegalNet, Inc. www.FormsWorkflow.com 3. The proposed unit includes: Nonprofessional employes only Professional employes only Professional and nonprofessional employes (refer to §604(2) of the Act) 4. Security guards only (refer to §604(3) of the Act) Prison guards only (refer to §604(3) of the Act) First level supervisors (refer to §604(5) of the Act) The Petitioner alleges that 30% or more of the employes in the proposed unit request representation/decertification in accordance with this petition, and is supported by __________________________________________________________________________. (State method used to determine the desire of the majority of employes) 5. There are no other employe representatives claiming to represent any of the employes in the proposed unit except (if applicable): _________________________________________________________________________________________________________ Name Telephone _________________________________________________________________________________________________________ Address City State Zip 6. Date of expiration of current agreement (if any): _________________________________________________________________ 7. The Employe Organization notified the public employer pursuant to Section 603(c) of the Act on ___________________________ (Date) and requested the public employer to join in a petition for an election; A COPY OF THE NOTIFICATION MUST BE ATTACHED. 8. The public employer refused said request on ____________________________. (Date) 9. The public employer agreed on ____________________ to join in an election request with the employe representative; (Date) however, the employe representative failed to seek an election. 10. Other relevant facts: _______________________________________________________________________________________ ________________________________________________________________________________________________________ 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 and Affiliation, if any) By _________________________________________________________________________________________________________ Signature of Petitioner or Representative Printed Name Title ___________________________________________________________________________________________________________ Address ___________________________________________________________________________________________________________ City State Zip Telephone INCOMPLETE OR INACCURATE STATEMENTS HEREON MAY RESULT IN A DISMISSAL OF THIS PETITION. FAILURE TO FILE ORIGINAL AND THREE (3) COPIES OF THE PETITION MAY CAUSE A DELAY IN PROCESSING. Pennsylvania Labor Relations Board | 651 Boas Street, Room 418 | Harrisburg, PA 17121-0750 717.787.1091 | Fax 717.783.2974 | www.dli.state.pa.us Auxiliary aids and services are available upon request to individuals with disabilities. Equal Opportunity employer/Program PERA-4 REV 5-09 (Page 2) American LegalNet, Inc. www.FormsWorkflow.com