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Improper Practice Charge - New York
| Improper Practice Charge Form. This is a New York form and can be used in Public Employment Relations Board Statewide . |
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STATE OF NEW YORK PUBLIC EMPLOYMENT RELATIONS BOARD IMPROPER PRACTICE CHARGE INSTRUCTIONS: File an original and four (4) copies of this Charge with the Director of Public Employment Practices and Representation, New York State Public Employment Relations Board, 80 Wolf Road, Suite 500, Albany, NY 12205-2656. If more space is required for any item, attach additional sheets, numbering item accordingly. DO NOT WRITE IN THIS SPACE Case No. UDate Received: 1. CHARGING PARTY a. Name (If employee organization, give full name, including any affiliation and local name and number): b. Address (No. & Street, City and Zip Code, County): Telephone Number: c. Name and title of the representative filing charge: d. Name, address and telephone number of attorney or other representative, if any, to whom correspondence is to be directed: Telephone Number: 2. PUBLIC EMPLOYER AND/OR EMPLOYEE ORGANIZATION AGAINST WHICH CHARGE IS BROUGHT a. Name and Address (No. & Street, City and Zip Code, County): b. Telephone Number: 3. Is the charging party filing a separate application for injunctive relief pursuant to ยง204.15 of the Board's Rules of Procedure? __ YES 4. VIOLATIONS ALLEGED Pursuant to Article 14 of the Civil Service Law, as amended (Public Employees' Fair Employment Act), the charging party hereby alleges that the above-named respondent(s) has (have) engaged in or is (are) engaging in an improper practice within the meaning of the following subsections of Section 209-a of said Act (check the subsection(s) allegedly violated): If by a public employer ( ( ( ( ( ( ( ) 209-a.1(a) ) 209-a.1(b) ) 209-a.1(c) ) 209-a.1(d) ) 209-a.1(e) ) 209-a.1(f) ) 209-a.1(g) If by an employee organization ( ) 209-a.2(a)* ( ) 209-a.2(b) ( ) 209-a.2(c)* __ NO * If the charge alleges a violation of Sections 209-a.2(a) and/or (c) of the Act based on an employee organization's processing of or failure to process a claim that a public employer has breached its agreement with such employee organization, identify the public employer: a. Name and Address (No. & Street, City and Zip Code, County): b. Telephone Number: American LegalNet, Inc. www.FormsWorkFlow.com 5. Specify in detail the alleged violation(s). Include names, dates, times, places and particular actions constituting each violation. Use additional sheet(s), if necessary. Failure to supply sufficient factual detail may result in a delay in processing or dismissal of the charge. 6. If the charge alleges a violation of Section 209-a.1(d) or 209-a.2(b) of the Act, has the charging party notified the Board in writing of the existence of an impasse pursuant to Section 205.1 of the Board's Rules of Procedure? ___ YES ___ NO 7. The charging party is available immediately to participate in a pre-hearing conference and a formal hearing. ___ YES ___ NO STATE OF NEW YORK COUNTY OF ) SS.: ) , being duly sworn deposes and says, that (s)he is the charging party above additional page(s), named, or its representative, and that (s)he has read the above charge consisting of this and and is familiar with the facts alleged therein, which facts (s)he knows to be true, except as to those matters alleged on information and belief, which matters (s)he believes to be true. (Signature) (Title) Subscribed and sworn to before me this ____ day of PERB 579 (3/12) American LegalNet, Inc. www.FormsWorkFlow.com
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