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Declaration Of Impasse - New York
| Declaration Of Impasse Form. This is a New York form and can be used in Public Employment Relations Board Statewide . |
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NEW YORK STATE PUBLIC EMPLOYMENT RELATIONS BOARD 80 WOLF ROAD, ALBANY, NEW YORK 12205 DECLARATION OF IMPASSE INSTRUCTIONS: Complete in full, retain one copy and distribute in the following manner: A) File an original and one (1) copy with the Director of Conciliation, PERB, 80 Wolf Road, Albany, New York 12205-2670. B) Simultaneously serve one (1) copy upon the respondent. Date: PUBLIC EMPLOYER Name of Public Employer.................................. NAME, TITLE, ADDRESS, TELEPHONE AND FAX NUMBERS of the Representative to whom PERB should direct correspondence (Telephone) EMPLOYEE ORGANIZATION Name of Employee Organization........................ NAME, TITLE, ADDRESS, TELEPHONE AND FAX NUMBERS of the Representative to whom PERB should direct correspondence (Telephone) (FAX) (FAX) Public Employer IDENTIFYING PARTY DECLARING IMPASSE Employee _____ Organization _____ DESCRIPTION OF UNIT Joint Declaration _____ A B C D - Number of employees in the unit: Included titles: Excluded titles: Employer's fiscal year: (Mo./Day/Yr.) to (Mo./Day/Yr.) to (Mo./Day/Yr.) (Mo./Day/Yr.) E - Effective date and expiration date of present agreement: F - Date of recognition or certification of negotiating agent: IMPORTANT DETAILS OF DECLARATION IMPORTANT On a Separate Sheet of Paper which should be attached hereto, write a clear and concise history of negotiations leading to this Declaration of Impasse. Include the number and dates of the negotiating sessions and specifically list all presently unresolved issues. Pursuant to Article 14 of the Civil Service Law, as amended (Public Employees' Fair Employment Act), the undersigned hereby declare(s) that a state of impasse exists between the above noted public employer and employee organization within the meaning of Section 209 of said Act. Signature of Representative Declaring Impasse Title Date If joint declaration, both representatives must sign: Signature of Representative Declaring Impasse Title Date American LegalNet, Inc. www.USCourtForms.com
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