Notice of Desire to Negotiate

MINNESOTA BUREAU OF MEDIATION SERVICES

Notice of Desire to Negotiate

(File a separate notice for each appropriate unit.)

Please complete the form below. Note that fields marked with an asterisk (*) are required. 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.

Is this Employer a Private or Public organization?	*	Public Private
Pursuant to Minnesota Statutes 179.06 or 179A.14, you are hereby notified of the undersigned's desire to meet and negotiate an initial or subsequent agreement establishing terms and conditions of employment.

Name of EMPLOYER	*
EMPLOYER Address	*
City	*	St* Zip*
Name of CHIEF NEGOTIATOR/CONTACT	*
Check if the following information is the same as above:	*	Yes No
CHF NEG/CONTACT Address
City		St Zip
Daytime Phone	*	Ext.
Cell Phone
E-Mail Address	*

Name of EXCLUSIVE REP	*
EXCLUSIVE REP Address	*
City	*	St* Zip*
Name of CHIEF NEGOTIATOR/CONTACT	*
Check if the following information is the same as above:	*	Yes No
CHF NEG/CONTACT Address
City		St Zip
Daytime Phone	*	Ext.
Cell Phone
E-Mail Address	*

Type of Employer	*
Type of Bargaining Unit	*
Status of Employees Involved: Essential?	*	Yes No
Number of Employees in Unit:	*
Expiration Date of Current Contract	*
First Contract?	*	Yes No

REQUESTOR MUST SEND A COPY OF THIS NOTICE TO THE OTHER PARTY(S).
Once the Notice has been submitted online, do NOT mail, fax or e-mail the original.
When properly executed and served upon the commissioner and the other party, this notice satisfies the requirements of Minn. Stat. 179.06 or 179A.14. Failure to provide timely notice may result in financial penalty.
QUESTIONS: BUREAU AT 651-649-5421

Notice Initiated By	*	Exclusive Representative Employer
Date of Notice	*
Date Requestor Sent Copy to Other Party Above:	*
Name of Person Filing this Notice	*	Title
E-Mail Address of Person Filing this Notice	*