Petition For Unit Amendment Form - Alaska Labor Relations Agency
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2ALASKA LABOR RELATIONS AGENCY
3301 EAGLE STREET, ROOM 208
P. O. BOX 107026
ANCHORAGE, ALASKA 99510-7026
(907) 269-4895 Fax (907) 269-4898
PETITION FOR UNIT AMENDMENT
Office use only
8 AAC 97.050(a)(2)
AMENDMENT OF CERTIFICATION IS FILED TO REFLECT CHANGED
CIRCUMSTANCES, INCLUDING A CHANGE IN NAME, AFFILIATION, SITE,
Date Filed
Case No.
OR LOCATION.
AC
INSTRUCTIONS:
File an original and one (1) copy of this petition with the Alaska Labor Relations Agency
at the above address. Attach two (2) copies of the supporting documentation. Serve a copy of this petition
and attachments on the employer or labor organization, as appropriate.
1a. Name of Employer
1b. Telephone Number
Facsimile Number
1c. Address
1d. Employer Representative
(street, city, state, and ZIP code)
2a. Name of currently recognized or certified bargaining agent and
2b. Telephone Number
affiliation.
Facsimile Number
2c. Address
2d. Contact Person
(street, city, state, and ZIP code)
(Name & Title)
2e. Expiration date of current contract, if any:
3. Other employee organizations known to have an interest in representing any employees described in item
four (4).
Name
Affiliation
Address
Contact Person
Phone/Fax
Nos.
4. AC - Unit Amendment - Petitioner seeks amendment of the following unit:
a. Name of unit:
b. Unit previously certified ¨ yes; ¨ no. Date of any certification
c. Number of employees in the unit
d. Approximate number of employees employed by the public employer
(Continued on Page 2.)
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