Organizing Forms

Proposed 2nd Election Start time if multiple times are needed

Including *

Email

Company Representative's Cell#

Company Address *

Company Fax

District/Local Lodge Number *

Representative's Name *

Shifts *

1st Shift

2nd Shift

3rd Shift

If yes, Pass Thru Date

Type of Product or Service *

Proposed Election Date *

Select if,

Usual Exclusions: office clerical, professional, managerial, guards and supervisors as defined in the act. Check in the box if you want the usual exclusions:

Email

Description of Unit/Classification *

Proposed 2nd election date, if needed

Company Phone *

Email *

Address

Phone *

Proposed 2nd Election End time if multiple times are needed

Who will deliver cards and when? *

Number of Petition Signature Cards *

Phone

Shift Time *

Type of Establishment (factory/garage/etc.) *

Company Name *

Company Email *

Check here to receive email updates

Proposed Election Start time *

Shifts *

Choose

Spanish

French

Arabic

Other

Phone *

Does this unit work for a Federal or State gov't agency or municipality? *

Yes

No

Number of Employees *

Today's Date *

Today's Date

Describe Action Taken *

District/Local Lodge Number *

Excluding *

Proposed Election End time *

Unit Address if different from Company Address

Company Name *

Company Address *

Company Representative's Name *

# of Employees on each shift: *

Representative's Name *

Representative Name *

Other Languages *

Yes

No

Company Representative's Title *

Company Name *

Classification *

Approx. Number of Employees *

Today's Date *

Is this SCA or Walsh-Healy

Yes

No

Preferred Voting Location *

Nature of Business (principal product/service) *

Day of Week Payroll Ends *

Select Activity *