Petition For Permission To Negotiate A Section 3201.7 Labor-Management Agreement - Department Of Industrial Relations, State Of California

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STATE OF CALIFORNIA
Department of Industrial Relations
Division of Workers' Compensation
Administrative Director
Post Office Box 420603
San Francisco, CA 94142-0603
Telephone: (510) 286-7100
Petition for Permission to Negotiate a Section 3201.7
Labor-Management Agreement
Labor Code §
3201.7; Title 8, California Code of Regulations
§ 10202
Please submit the following information to the Administrative Director of the Division of
Workers' Compensation to obtain a letter advising the below-named union and employer, or
group of employers, of their eligibility to enter into negotiations for the purpose of reaching
agreement on a labor-management agreement authorized by
Section 3201.7
of the California
Labor Code.
(Print or Type Name and Addresses)
1. Union Information
Name of Union: ________________________________________________________________
Contact Person and Title: _________________________________________________________
Principal Address: ______________________________________________________________
2. Employer Information (For group of employers, please use separate pages to list all individual
employers.)
Name of Employer: _____________________________________________________________
Contact Person and Title: _________________________________________________________
Federal Employers Identification Number (FEIN): _____________________________________
Principal Business of Employer: ___________________________________________________
Principal Address: ______________________________________________________________
3. Please describe the bargaining unit or units to be covered by the Section 3201.7 labor-
management agreement, and provide the approximate number of employees in the unit(s).
4. Please attach proof of the union's status as the exclusive bargaining representative of the
employees in the above-described bargaining unit(s).
5. Please attach a copy of the current collective bargaining agreement or agreements in effect
between the union and the employer.
1
DWC Form RGS-1 (012004)

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