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	

STIPULATION FOR ELECTION
(Pursuant to § 8111.05 of WEPA or § 111.70(4)(d) of MERA or §111.83 of SELRA) 

It is agreed between the Employer and the Labor Organizations named below that the following circumstances exist and the below‑named parties hereby request the Wisconsin Employment Relations Commission, pursuant to ch. 111, Stats., to determine whether the employees in the collective bargaining units desire to be represented by a labor organization by conducting an election, without a previous hearing, in accordance with the rules and procedures of the Commission, at a time, place and manner to be determined by the Commission, among the employees in the collective bargaining units stated below and to certify to the parties the results of such election.

The individuals listed on the Eligibility List, attached hereto and made a part hereof, constitute all of the employees in the below agreed upon collective bargaining units who are eligible to participate in the election, unless any of those employees leave employment prior to the election.  Unless mutually agreed otherwise, any new employee(s) hired in the positions in the below-described bargaining units prior to the date on which the Commission issues the Direction of Election in this matter will be eligible to vote.
	
All Information is Required	
Name of Labor Organization #1	Name of Employer	
		
Name of Representative	Name of Representative	
		
Street Address, City, State, Zip Code	Street Address, City, State, Zip Code	
		
Telephone No.	Email Address	Telephone No.	Email Address	
				
Name of Labor Organization #2		
		
Name of Representative	Name of Representative	
		
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	
	
Select Applicable Statement:	
  Unit includes craft employees
  Unit includes professional employees
  Unit consists of supervisory employees
  Unit includes none of the above	
Employer By		Signature		Date		
Labor Organization #1 By		Signature		Date		
Labor Organization #2 By		Signature		Date