Charge Of Unfair Labor Practices {PLRB-15}

PLRB-15 REV 5-00 COMMONWEALTH OF PENNSYLVANIA Pennsylvania Labor Relations Board ______________________________________ COMPLAINANT v. DO NOT WRITE IN THIS SPACE Case No. Date Filed ______________________________________ RESPONDENT CHARGE OF UNFAIR LABOR PRACTICES TO THE HONORABLE, THE MEMBERS OF THE PENNSYLVANIA LABOR RELATIONS BOARD: The Complainant,_______________________________________________________________________________ (name of employe, labor organization or employer) by and through_________________________________________________________________________________ (name and title of person filing charge) _____________________________________________________________________________________________ (address, zip code, telephone number of person filing charge) HEREBY CHARGES that Respondent,________________________________________________________________________________ (employer, labor organization or employe alleged to have committed unfair labor practices) of ___________________________________________________________________________________________ (address, zip code, telephone number) has engaged in unfair labor practices contrary to the provisions of the Pennsylvania Labor Relations Act, Section 6, subsection (1) or (2), clause(s) (a), (b), (c), (d), (e), (f). (Using cursor, click on and block subsection and clauses inapplicable prior to filing with the Board.) If more than one Respondent, place X in block and list on separate sheet. If X is placed in block, please send a If a grievance relating to this issue has been filed, place X in block. copy of the grievance and the contract to assist in review of this charge. (over) American LegalNet, Inc. www.FormsWorkflow.com SPECIFICATION OF CHARGES Set forth all of the events alleged to constitute the unfair labor practice(s). Include specific facts, dates, names, addresses, place of occurrence, and other relevant facts. If additional space is needed, please continue on additional sheet(s) (8½" x 11"). WHEREFORE, the Complainant respectfully requests the Pennsylvania Labor Relations Board to enter the charge upon the Docket of the said Board and to issue and cause to be served upon the Respondent above named a Complaint stating the charge(s) of unfair labor practice(s). ___________________________________________________ Signature of Complainant or Representative COMMONWEALTH OF PENNSYLVANIA : : ss COUNTY OF : On this_____________________________day of____________________________ , 20_________, before me, a __________________________________________, in and for said County and State, personally appeared ____________________________________, who being duly sworn according to law, deposes and says that he/she is the person filing the foregoing CHARGE OF UNFAIR LABOR PRACTICES and is aware of the contents thereof and that the matters and facts set forth therein are true and correct to the best of his or her knowledge, information and belief. SWORN AND SUBSCRIBED TO before me the day and year first aforesaid. _______________________________________ Signature of Notary Public ___________________________________________ Signature of Complainant or Representative FAILURE TO FILE AN ORIGINAL AND 3 COPIES OF THE CHARGE AND ALL ACCOMPANYING EXHIBITS MAY DELAY PROCESSING American LegalNet, Inc. www.FormsWorkflow.com