Joint Submission To Arbitrate

NEW YORK STATE PUBLIC EMPLOYMENT RELATIONS BOARD 80 WOLF ROAD, SUITE 500, ALBANY, NEW YORK 12205-2656 VOLUNTARY GRIEVANCE ARBITRATION RULES OF PROCEDURE WWW.PERB.NY.GOV JOINT SUBMISSION TO ARBITRATE INSTRUCTIONS: Complete in full, retain one copy each and forward an original and one (1) copy to the Director of Conciliation, NYS PERB, 80 Wolf Road, Suite 500, Albany, New York 12205-2656, along with the $50.00 per party filing fee in the form of a check or money order made payable to the State of New York. DATE: ______________________ PUBLIC EMPLOYER Name of Public Employer . . . . . . . _________________________________________________________________ Name, Title, Address and Telephone _________________________________________________________________ Number of the Representative to whom PERB should direct __________________________________________ correspondence. __________________________________________________________________ __________________________________________________________________ EMPLOYEE ORGANIZATION Name of Employee Organization . . . . __________________________________________________________________ Name, Title, Address and Telephone __________________________________________________________________ Number of the Representative to whom PERB should direct __________________________________________ correspondence. __________________________________________________________________ __________________________________________________________________ (ATTACH ADDITIONAL SHEETS WHERE NECESSARY) 1. Identify the provision(s) in the agreement claimed to be violated and attach a copy thereof: 2. Write a clear and concise description of the nature of the dispute(s) to be arbitrated and the remedy(ies) sought (include the name(s) of the grievant(s)): American LegalNet, Inc. www.FormsWorkFlow.com THE PARTIES NAMED HEREIN, HEREBY JOINTLY REQUEST BINDING ARBITRATION OF THE DISPUTE DESCRIBED HEREIN UNDER THE VOLUNTARY ARBITRATION RULES OF PROCEDURE OF THE NEW YORK STATE PUBLIC EMPLOYMENT RELATIONS BOARD. ___________________________________________ __________________ ___________ Signature of Public Employer Representative Title Date __________________________________________ __________________ ___________ Signature of Employee Organization Title Date Representative American LegalNet, Inc. www.FormsWorkFlow.com