RM Petition {NLRB-502 (RM)}

FORM NLRB-502 (RM) (2-18)UNITED STATES OF AMERICA NATIONAL LABOR RELATIONS BOARD RM PETITION DO NOT WRITE IN THIS SPACE Case No. Date Filed 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 certificate of service showing service on all parties named in the petition of the following: (1) the petition; (2) Statement of Position form; and (3) Description of Procedures in Certification and Decertification Cases (Form NLRB 4812). The petition must also be accompanied by evidence supporting the statement that a labor organization has made a demand for recognition on the employer or that the employer has good faith uncertainty about majority support for an existing representative. However, if the evidence reveals 1. PURPOSE OF THIS PETITION: RM-CERTIFICATION OF REPRESENTATIVE - One or more individuals or labor organizations have presented a claim to the Employer/Petitioner to be recognized as the representative of employees of the Employer/Petitioner or the Employer/Petitioner has a good faith uncertainty about majority support for an existing representative. If a charge under Section 8(b)(7) of the Act has been filed involving the Employer/Petitioner named in this petition, this statement shall not be deemed made. The Petitioner alleges that the following circumstances exist and requests that the National Labor Relations Board proceed under its proper authority pursuant to Section 9 of the National Labor Relations Act. 2a. Name of Employer/Petitioner: 2b. Address(es) of Establishment(s) involved (Street and number, City, State, ZIP code): 3a. Employer/Petitioner Representative - Name and Title: 3b. Address 3c. Tel. No. 3d. Cell No. 3e. Fax No. 3f. E-Mail Address 4a. Type of Establishment (Factory, mine, wholesaler, etc.) 4b. Principal Product or Service 5a. Description of Unit Involved: Included: Excluded: 5b. City and State where unit is located: 6. Number of Employees in Unit: Unless a charge alleging a violation of Section 8(b)(7) is pending, check 7a. A labor organization made a demand for recognition on the Employer/Petitioner on (Date) 7b. The Employer/Petitioner has a good faith uncertainty about majority support for an existing representative. 8a. Name of Recognized or Certified Bargaining Agent - Name 8c. Address: 8d. Tel. No. 8e. Cell No. 8f. Fax No. 8g. E-Mail Address 8b. Affiliation, if any: 9. Date of Recognition or Certification 10. Expiration Date of Current or Most Recent Contract, if any 11. 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 Employer since (Month, Day, Year) 12. Organizations or individuals other than those named in item 8, which have a contract with the Employer/Petitioner or represent employees of the Employer/Petitioner or demanded recognition as representatives and other organization and individuals known to have a representative interest in any employees in the unit described in item 5 above. (If none, so state) 12a. Name and affiliation if any 12b. Address 12c. Tel. No. 12d. Cell No. 12e. Fax No. 12f. E-Mail Address Manual Mail Mixed Manual/Mail 13a. Election Type: 13b. Election Date(s): 13c. Election Time(s): 13d. Election Location(s): 14. Representative of the Employer/Petitioner who will accept service of all papers for purposes of the representation proceeding. 14b. Address (street and number, city, State and ZIP code): 14c. Tel. No. 14d. Cell No. 14e. Fax No. 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. Name (Print) Signature Title DateWILLFUL 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 f www.nlrb.gov/