State of Wisconsin
Employment Relations Commission
2418 Crossroads Drive, Suite 1000, Madison, WI  53718-7896
Phone:  608-243-2424    Fax:  608-243-2433
Email:  werc@werc.state.wi.us	

PETITION FOR ELECTION
(Pursuant to § 111.05 of WEPA or § 111.70(4)(d) of MERA or § 111.83 of SELRA)
	
Complete and submit this form and attach a showing of interest in support of the request if required.

The initiating party requests the Wisconsin Employment Relations Commission to conduct an election among the employees of the Employer named herein and to certify to the parties the results of such election.	
All Information is Required	
Name of Labor Organization	Name of Employer	
		
Street Address, City, State, Zip Code	Street Address, City, State, Zip Code	
		
Telephone No.	Email Address	Telephone No.	Email Address	
				
Name of Representative	Name of Representative	
		
Street Address, City, State, Zip Code (if different)	Street Address, City, State, Zip Code (if different)	
		
Telephone No.	Email Address	Telephone No.	Email Address	
				
Name of Representative (if needed)	Name of Representative (if needed)	
		
Street Address, City, State, Zip Code 	Street Address, City, State, Zip Code	
		
Telephone No.	Email Address	Telephone No.	Email Address	
				
Describe the Collective Bargaining Unit with Inclusions and Exclusions	
	
Approximate Number of Employees in Bargaining Unit		
Select Applicable Statement:	
  Unit includes craft employees
  Unit includes professional employees
  Unit consists of supervisory employees
  Unit includes none of the above	
List the Name, Address, Telephone Number, and Email Address of Any Union Who Currently Represents the Employees Involved.	

	
I declare that I have read the contents of this petition and that the statements it contains are true and correct to the best of my knowledge.	
Name		Title		
Signature		Date