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 TO CLARIFY BARGAINING UNIT
(Pursuant to ch. 111, Stats.)

Complete and submit this form and, at the same time, serve a copy on the other party, if not filed jointly.

The Initiating Party(ies) request(s) the Wisconsin Employment Relations Commission, pursuant to ch. 111, Stats., to clarify the collective bargaining unit. 
	
INITIATING PARTY OR PARTIES:	
 	Labor Organization	
	Employer	
	Joint	
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:	
  Certified*
  Voluntarily Recognized	*If Certified, Provide Date and Decision Number of Certification		
List the Name, Address, Telephone Number, and Email Address of Any Union Who Currently Represents the Employees Involved.	
	
CLARIFICATION REQUESTED
Identify position(s) and number of employees in the position(s) requested to be included in, or excluded from, existing collective bargaining unit and state the reason for the proposed inclusion or exclusion of each position.	

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