Request for Amendment of Certification of Exclusive Representative
(Organization Name Change Form)
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
Name of Employer:
*
Full Name of Union or Organization
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Employer Representative or Counsel:
*
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
(Optional) Employer Chief Negotiator:
First Name
Last Name
Name of Current Union or Organization:
*
Full Name of Current Union or Organization
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 Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
New Name of Union or Organization:
*
Updated Constitution and By Laws reflecting new name:
*
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Bargaining Unit Type:
*
Please Select
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 of Capts
Police Department / Sergeant Only
Professional
Probation Officers
Public Defenders
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
Wall to Wall
Employer Type:
*
Please Select
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
Description of CURRENT Unit(s):
*
BMS Unit Determination Description
Date Petitioner Will Send Copy to Other Party(s):
*
-
Month
-
Day
Year
Date
Name of Person Filing this Petition:
*
First Name
Last Name
E-Mail Address of Person Filing:
example@example.com
Signature:
*
Submit Form
Should be Empty: