Fillable Nlrb-505, 2015, Statement Of Position Form (Page 2 of 3) in pdf

DO NOT WRITE IN THIS SPACE

FORM NLRB-505

UNITED STATES OF AMERICA

(4-15)

Case No.

Date Filed

NATIONAL LABOR RELATIONS BOARD

STATEMENT OF POSITION

INSTRUCTIONS: Submit this Statement of Position to an NLRB Office in the Region in which the petition was filed and serve it and all attachments

on each party named in the petition in this case such that it is received by them by the date and time specified in the notice of hearing.

Note: Non-employer parties who complete this form are NOT required to complete items 8f or 8g below or to provide a commerce questionnaire

or the lists described in item 7. In RM cases, the employer is NOT required to respond to items 3, 5, 6, and 8a-8e below.

1a. Full name of party filing Statement of Position:

1c. Business Phone:

1e. Fax No.:

1b. Address (Street and number, city, state, and ZIP code):

1d. Cell No.:

1f. e-Mail Address:

Yes

2. Do you agree that the NLRB has jurisdiction over the Employer in this case?

(A completed commerce questionnaire (Attachment A) must be submitted by the Employer, regardless of whether jurisdiction is admitted)

Yes

3. Do you agree that the proposed unit is appropriate?

(If not, answer 3a and 3b.)

a. State the basis for your contention that the proposed unit is not appropriate. (If you contend a classification should be excluded or included briefly explain why,

such as shares a community of interest or are supervisors or guards.)

b. State any classifications, locations, or other employee groupings that must be added to or excluded from the proposed unit to make it an appropriate unit.

Added:

Excluded:

4. Other than the individuals in classifications listed in 3b, list any individual(s) whose eligibility to vote you intend to contest at the pre-election hearing in this case

and the basis for contesting their eligibility.

5. Is there a bar to conducting an election in this case?

Yes

If yes, state the basis for your position.

6. Describe all other issues you intend to raise at the pre-election hearing.

7. The employer must provide the following lists which must be alphabetized (overall or by department) in the format specified at

(a) A list containing the full names, work locations, shifts and job classification of all individuals in the proposed unit as of the payroll period immediately preceding

the filing of the petition who remain employed as of the date of the filing of the petition. (Attachment B)

(b) If the employer contends that the proposed unit is inappropriate the employer must provide (1) a separate list containing the full names, work locations, shifts

and job classifications of all individuals that it contends must be added to the proposed unit, if any to make it an appropriate unit, (Attachment C) and (2) a list

containing the full names of any individuals it contends must be excluded from the proposed unit to make it an appropriate unit. (Attachment D).

8a. State your position with respect to the details of any election that may be conducted in this matter. Type:

Manual

Mail

Mixed Manual/Mail

8b. Date(s):

8c. Time(s):

8d. Location(s):

8e. Eligibility Period (e.g. special eligibility formula):

8f. Last Payroll Period Ending Date:

8g. Length of payroll period

Weekly

Biweekly

Other (specify length)

9. Representative who will accept service of all papers for purposes of the representation proceeding

9a. Full name and title of authorized representative

9b. Signature of authorized representative

9c. Date

9d. Address (Street and number, city, state, and ZIP code)

9e. e-Mail Address

9f. Business Phone No.:

9g. Fax No.:

9h. Cell No.:

WILLFUL FALSE STATEMENTS ON THIS PETITION CAN BE PUNISHED BY FINE AND IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001)

PRIVACY ACT STATEMENT

Solicitation of the information on this form is authorized by the National Labor Relations Act (NLRA), 29 U.S.C. Section 151 et seq. The principal use of the information is to assist the National Labor Relations

Board (NLRB) in processing representation proceedings. The routine uses for the information are fully set forth in the Federal Register, 71 Fed. 74942-43 (December 13, 2006). The NLRB will further explain these

uses upon request. Failure to supply the information requested by this form may preclude you from litigating issues under 102.66(d) of the Board's Rules and Regulations and may cause the NLRB to refuse to

further process a representation case or may cause the NLRB to issue you a subpoena and seek enforcement of the subpoena in federal court.