Petition for Decertification Election

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 651-649-5421 or mediation.services.bms@state.mn.us.

Is the Employer a Private or Public organization?	*	Public Private
The undersigned petitioner requests that the Minnesota Bureau of Mediation Services investigate the above referenced matter and resolve such in accordance with applicable state law (Minn. Stat. Chapter 179 and 179A).

Name of PETITIONER	*
PETITIONER Address	*
City	*	St* Zip*
Name of REPRESENTATIVE	*
Check if the following information is the same as above:	*	Yes No
REPRESENTATIVE Address
City		St Zip
Daytime Phone	*	Ext.
Cell Phone
E-Mail Address	*
Check if the following information is the same as above:	*	Yes No
Name of LEGAL COUNSEL/CONSULTANT (if any)
COUNSEL/CONSULTANT Address
City		St Zip
Daytime Phone		Ext.
Cell Phone
E-Mail Address

Name of EMPLOYER	*
EMPLOYER Address	*
City	*	St* Zip*
Name of REPRESENTATIVE	*
Check if the following information is the same as above:	*	Yes No
REPRESENTATIVE Address
City		St Zip
Daytime Phone	*	Ext.
Cell Phone
E-Mail Address	*
Check if the following information is the same as above:	*	Yes No
Name of LEGAL COUNSEL/CONSULTANT (if any)
COUNSEL/CONSULTANT Address
City		St Zip
Daytime Phone		Ext.
Cell Phone
E-Mail Address

Name of EXCLUSIVE REP	*
EXCLUSIVE REP Address	*
City	*	St* Zip*
Name of REPRESENTATIVE	*
Check if the following contact information is the same as above:	*	Yes No
REPRESENTATIVE Address
City		St Zip
Daytime Phone	*	Ext.
Cell Phone
E-Mail Address	*
Check if the following contact information is the same as above:	*	Yes No
Name of LEGAL COUNSEL/CONSULTANT (if any)
COUNSEL/CONSULTANT Address
City		St Zip
Daytime Phone		Ext.
Cell Phone
E-Mail Address

Type of Employer	*
Expiration Date of Current Contract	*

Open Window Information:
Public: A single party petition is timely if it is filed during the open-window period. Open-window period means the following period of time prior to the expiration of a labor contract:
A. For state executive branch: 270 to 210 days;
B. For teachers, 180 to 120 days; and
C. For all other public employees, 120 to 60 days.
The Bureau also accepts single party petitions after a contract has expired and no new contract has been ratified.
Private: A single party petition is timely if it is filed during the open-window period. Open-window period means the following period of time prior to the expiration of a labor contract: 90 to 60 days.
The Bureau also accepts single party petitions after a contract has expired and no new contract has been ratified.

Number of employees covered by this request	*
Description of Certified Unit	*

DEAUTHORIZATION CARDS SUBSTANTIATING AT LEAST A 30% SHOWING OF INTEREST IN SUPPORT OF THIS PETITION MUST BE SUBMITTED TO THE BUREAU OF MEDIATION SERVICES BY MAIL, FAX OR HAND DELIVERY BEFORE THIS PETITION WILL BE PROCESSED. BE CERTAIN TO IDENTIFY THE EMPLOYER WHEN SUBMITTING THE CARDS.
FAX: 651-643-3013
MAIL: 1380 ENERGY LANE, SUITE 2, ST. PAUL, MN 55108
QUESTIONS: 651-649-5421
NOTE: Once the Petition has been submitted online, do NOT mail, fax or e-mail the original.


Date of Petition:	*
Name of Person Filing this Petition	*	Title
E-Mail Address of Person Filing this Petition	*