UD Petition {NLRB-502 (UD)}

UNITED STATES OF AMERICA 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 a showing of interest (see 6b below). When filed with the NLRB, the petition must be accompanied by a showing of interest (see 6b below) that should not be served on any party. 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) - 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: 8. Date of Recognition or Certification 9. Execution & Expiration Dates of Current or Most Recent Contract, if any (Month, Day, Year) 11f. E-Mail Address (Street and number, city, state, ZIP code) 14f. 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. 14. Representative of the Petitioner who will accept service of all papers for purposes of the representation proceeding. (Street and number, city, state, ZIP code) 13f. E-Mail Address (including local name and number if applicable) (if none, so state) 12.Election Details: If the NLRB conducts an election in this matter, state your position with respect to any such election. 7g. Affiliation 6. Number of Employees in Unit: 7a. Name of Recognized or Certified Bargaining Agent (if none, so state) 7b. Address 7f. E-Mail Address 11. Organizations or individuals and those named in items 7 and 10, 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) 12a. Election Type: Manual Mail Mixed Manual/Mail 6b. Do a substantial number (30% or more) of the employees in the unit desire to rescind the authority of the labor organization to require, under an agreement, that employees make certain lawful payments to that labor organization in order to retain their jobs: Yes No 10. Is there now a strike or picketing at the Employer's establishment(s) involved? If so, approximately how many employees are participating? (Name of labor organization) , has picketed the Employee since (Month, Day, Year) 12b. Election Date(s): 12c. Election Time(s): 12d. Election Location(s): PRIVACY ACT STATEMENT Solicitation of the information on this form is authorized by the National Labor Relations Act (NLRA), 29 U.S.C. 247 151 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 willfurther 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. www.nlrb.gov/