Petition for Mediation Services
Please complete the form below. Once the form has been submitted, you will receive an e-mail response with a copy of all data submitted.
If you have any questions while completing the form, contact the Bureau at 651-649-5421.
Sector:
*
Public
Private
Hospital
Petition Type:
*
Contract
Grievance
Interest-Based Collective Bargaining (Checking this box acknowledges that both parties request interest-based facilitation.)
If Grievance:
Required by Contract
Voluntary Agreement to Mediate
Name of Employer:
*
Full Name of Employer
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Employer Representative:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email
*
example@example.com
Name of Union:
*
Full Name of UNION Organization. (Not an individual or representative name.)
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Union Representative or Counsel:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
*
Please enter a valid phone number.
E-Mail Address:
*
example@example.com
Type of Employer:
*
Please Select
- - - Select One - - -
Board / Commission
City
County
EMS – Other than City or Hospital
Fire District – Other than City
Higher Education
Hospital
Joint Powers
Municipal Utility
School District
State
University
Other Public
Bargaining Unit Type:
*
Please Select
- - - Select One - - -
Private Employer Bargaining Unit
911 Dispatchers
911 Dispatchers – Lead / Manager
Administrative / Clerical
Attorneys – City / County
Confidential
Corrections
Fire Department / All Fire Fighters
Fire Department / Captains Only
Fire Department / Chief Officers Only
Health Care Technical
Health / Human Service
Higher Education – Instructional
Higher Education – Non-Instructional
Library – Professional
Library – Other
Nurses
Paramedic / EMT
Police Department / All Peace Officers
Police Department / Chief Officers Only
Police Department / Lts or Capts
Police Department / Sergeant Only
Professional
School Clerical
School Custodian / Maintenance
School Food Service
School Para / Aides
School Principals / Asst. Principals
School Transportation
School Other
Sheriff Dept / Deputies
Sheriff Dept / Ranking Officers
Streets / Highway / Public Works
Supervisory Unit – General
Teachers K-12
Teachers Other
Transit / Transportation - Other
Wall to Wall
Number of Employees in Unit:
*
Number of Prior Negotiating Meetings Held:
Date of 1st Negotiating Meeting:
-
Month
-
Day
Year
Date
Do not include name of Grievant if discipline related.
Remaining Contract Negotiation Issues -OR-Concise Statement of Grievance):
*
Expiration Date of Current Contract:
*
-
Month
-
Day
Year
Date
Date Petitioner Will Send Copy to Other Party(s):
*
-
Month
-
Day
Year
Date
Name of Person Filing Petition:
*
First Name
Last Name
E-Mail Address of Person Filing:
*
example@example.com
Signature:
*
Submit Form
Should be Empty: