Form PERA-4 "Petition Under the Public Employe Relations Act" - Pennsylvania

What Is Form PERA-4?

This is a legal form that was released by the Pennsylvania Department of Labor & Industry - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2009;
  • The latest edition provided by the Pennsylvania Department of Labor & Industry;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PERA-4 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Labor & Industry.

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Download Form PERA-4 "Petition Under the Public Employe Relations Act" - Pennsylvania

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PETITION UNDER THE
PUBLIC EMPLOYE RELATIONS ACT
DO NOT WRITE IN THIS SPACE
IN THE MATTER OF THE EMPLOYES OF:
CASE NO.
DATE FILED
PETITION FOR REPRESENTATION – Thirty (30) percent or more of the employes wish to be represented by Petitioner and Petitioner
desires to be certified as representative of the employes; SIGNED AND DATED SHOWING OF INTEREST MUST BE ATTACHED
(refer to § 603(c) of the Public Employe Relations Act (Act) and 34 Pa. Code §§ 95.12 and 95.14).
PETITION FOR DECERTIFICATION – Thirty (30) percent or more of the employes assert that the certified bargaining representative is
no longer their representative (SIGNED AND DATED SHOWING OF INTEREST MUST BE ATTACHED) or the public employer alleges
a good faith doubt of the majority status of the present representative; (FACTUAL SUPPORT MUST BE ATTACHED) (refer to § 607 of
the Act and 34 Pa. Code §§ 95.21 and 95.22).
PETITION FOR ELECTION BY PUBLIC EMPLOYER –A public employe, group of public employes, or employe organization has
presented a claim to the public employer to be recognized as the representative of the employes of the public employer and thereafter
has not sought an election (refer to § 603(d) of the Act and 34 Pa. Code § 95.14).
PETITION FOR UNIT CLARIFICATION – An employe organization is currently recognized by the public employer, but Petitioner seeks
clarification of the unit previously certified in Case No. ______________________________ (refer to 34 Pa. Code § 95.23).
PETITION FOR AMENDMENT OF CERTIFICATION – Petitioner seeks amendment of certification issued in
Case No.___________________________; STATEMENT DESCRIBING THE SPECIFIC AMENDMENT SOUGHT MUST BE
ATTACHED (refer to 34 Pa. Code § 95.23).
PUBLIC EMPLOYER INFORMATION
________________________________________________________________________________________________________________________
Public Employer
Contact Name
________________________________________________________________________________________________________________________
Address
________________________________________________________________________________________________________________________
City
State
Zip
Telephone
EMPLOYE ORGANIZATION INFORMATION
________________________________________________________________________________________________________________________
Employe Organization
Contact Name
________________________________________________________________________________________________________________________
Address
________________________________________________________________________________________________________________________
City
State
Zip
Telephone
1.
Description of the unit deemed to be appropriate (for Unit Clarification Petitions, describe present unit below and attach description of
proposed clarification and reason(s) for the request):
Included:
Excluded:
2.
Approximate number of employes in the unit claimed to be appropriate:
Present: _____
Proposed by Unit Clarification Petition: _____
PERA-4 REV 5-09 (Page 1)
PETITION UNDER THE
PUBLIC EMPLOYE RELATIONS ACT
DO NOT WRITE IN THIS SPACE
IN THE MATTER OF THE EMPLOYES OF:
CASE NO.
DATE FILED
PETITION FOR REPRESENTATION – Thirty (30) percent or more of the employes wish to be represented by Petitioner and Petitioner
desires to be certified as representative of the employes; SIGNED AND DATED SHOWING OF INTEREST MUST BE ATTACHED
(refer to § 603(c) of the Public Employe Relations Act (Act) and 34 Pa. Code §§ 95.12 and 95.14).
PETITION FOR DECERTIFICATION – Thirty (30) percent or more of the employes assert that the certified bargaining representative is
no longer their representative (SIGNED AND DATED SHOWING OF INTEREST MUST BE ATTACHED) or the public employer alleges
a good faith doubt of the majority status of the present representative; (FACTUAL SUPPORT MUST BE ATTACHED) (refer to § 607 of
the Act and 34 Pa. Code §§ 95.21 and 95.22).
PETITION FOR ELECTION BY PUBLIC EMPLOYER –A public employe, group of public employes, or employe organization has
presented a claim to the public employer to be recognized as the representative of the employes of the public employer and thereafter
has not sought an election (refer to § 603(d) of the Act and 34 Pa. Code § 95.14).
PETITION FOR UNIT CLARIFICATION – An employe organization is currently recognized by the public employer, but Petitioner seeks
clarification of the unit previously certified in Case No. ______________________________ (refer to 34 Pa. Code § 95.23).
PETITION FOR AMENDMENT OF CERTIFICATION – Petitioner seeks amendment of certification issued in
Case No.___________________________; STATEMENT DESCRIBING THE SPECIFIC AMENDMENT SOUGHT MUST BE
ATTACHED (refer to 34 Pa. Code § 95.23).
PUBLIC EMPLOYER INFORMATION
________________________________________________________________________________________________________________________
Public Employer
Contact Name
________________________________________________________________________________________________________________________
Address
________________________________________________________________________________________________________________________
City
State
Zip
Telephone
EMPLOYE ORGANIZATION INFORMATION
________________________________________________________________________________________________________________________
Employe Organization
Contact Name
________________________________________________________________________________________________________________________
Address
________________________________________________________________________________________________________________________
City
State
Zip
Telephone
1.
Description of the unit deemed to be appropriate (for Unit Clarification Petitions, describe present unit below and attach description of
proposed clarification and reason(s) for the request):
Included:
Excluded:
2.
Approximate number of employes in the unit claimed to be appropriate:
Present: _____
Proposed by Unit Clarification Petition: _____
PERA-4 REV 5-09 (Page 1)
3.
The proposed unit includes:
Nonprofessional employes only
Security guards only (refer to §604(3) of the Act)
Professional employes only
Prison guards only (refer to §604(3) of the Act)
Professional and nonprofessional employes
First level supervisors (refer to §604(5) of the Act)
(refer to §604(2) of the Act)
4.
The Petitioner alleges that 30% or more of the employes in the proposed unit request representation/decertification in accordance
with this petition, and is supported by __________________________________________________________________________.
(State method used to determine the desire of the majority of employes)
5.
There are no other employe representatives claiming to represent any of the employes in the proposed unit except
(if applicable):
_________________________________________________________________________________________________________
Name
Telephone
_________________________________________________________________________________________________________
Address
City
State
Zip
6.
Date of expiration of current agreement (if any): _________________________________________________________________
7.
The Employe Organization notified the public employer pursuant to Section 603(c) of the Act on ___________________________
(Date)
and requested the public employer to join in a petition for an election; A COPY OF THE NOTIFICATION MUST BE ATTACHED.
8.
The public employer refused said request on ____________________________.
(Date)
9.
The public employer agreed on ____________________ to join in an election request with the employe representative;
(Date)
however, the employe representative failed to seek an election.
10. Other relevant facts:
I declare that I have read the above petition and that the statements therein are true to the best of my knowledge and belief.
___________________________________________________________________________________________________________
(Petitioner and Affiliation, if any)
By _________________________________________________________________________________________________________
Signature of Petitioner or Representative
Printed Name
Title
___________________________________________________________________________________________________________
Address
___________________________________________________________________________________________________________
City
State
Zip
Telephone
INCOMPLETE OR INACCURATE STATEMENTS HEREON MAY RESULT IN A DISMISSAL OF THIS PETITION.
FAILURE TO FILE ORIGINAL AND THREE (3) COPIES OF THE PETITION MAY CAUSE A DELAY IN PROCESSING.
Pennsylvania Labor Relations Board | 651 Boas Street, Room 418 | Harrisburg, PA 17121-0750
717.787.1091 | Fax 717.783.2974 | www.dli.state.pa.us
Auxiliary aids and services are available upon request to individuals with disabilities.
Equal Opportunity employer/Program
PERA-4 REV 5-09 (Page 2)
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