In the dynamic landscape of labor relations within the State of Florida, the PERC 4 form emerges as a critical document for those seeking to navigate the intricacies of representation certification petitions. Administered by the Public Employees Relations Commission, located at 4050 Esplanade Way, Tallahassee, this form is a gateway for petitioner entities wishing to procure or alter representation rights for collective bargaining purposes. Required to be submitted with an original and a copy, alongside proof of service upon involved parties, it embarks on detailing the petitioner's identity, representative credentials, and the pertinent registration numbers. Additionally, it delves into characterizing the employer involved, encapsulating the entity's representative information and addresses. The form takes a keen interest in the description of the unit proposed for collective bargaining, highlighting job classifications included and excluded, the approximate number of employees, and vital statistics related to the expression of interest among potential unit members. Significantly, it probes the existence of a currently certified bargaining agent and the status of any pre-existing collective bargaining contracts. Culminating with a declaration under oath regarding the veracity of the information provided, the PERC 4 form stands as a testament to the structured approach Florida adopts in managing the delicate balance of employer-employee relations through collective bargaining mechanisms.
| Question | Answer |
|---|---|
| Form Name | Perc Form 4 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | RCDATE, CERTIFICATION, FLORIDA, ORExpiration |
Do Not Write In This Box
STATE OF FLORIDA
PUBLIC EMPLOYEES RELATIONS COMMISSION
4050 Esplanade Way
Tallahassee, Florida
(850)
REPRESENTATION - CERTIFICATION PETITION
CASE NUMBER
RC-
DATE FILED
INSTRUCTIONS:
Submit an original and one (1) copy of this petition to the Public Employees Relations Commission along with proof of simultaneous service upon the other parties. If more space is required for any item, attach additional sheets numbering items accordingly.
Petitioner requests the Public Employees Relations Commission to process this petition under its proper authority.
1.NAME OF PETITIONER: Address:
Zip Code
2.PETITIONER REPRESENTATIVE: Title:
Phone No. |
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Address: |
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Zip Code
3.PERC REGISTRATION NUMBER OF PETITIONER: OR- Expiration of current registration:
4.NAME OF EMPLOYER: Address:
Zip Code
5.EMPLOYER REPRESENTATIVE: Title:
Phone No. |
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Facsimile(Fax) No. |
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Address: |
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Zip Code
PERC Form 4
Page 1 of 2 (Rev. 6/07)
6.DESCRIPTION OF UNIT proposed to be appropriate for the purpose of collective bargaining. (List individually all job classifications proposed for inclusion.)
INCLUDED:
EXCLUDED:
7.APPROXIMATE NUMBER OF EMPLOYEES in the unit claimed to be appropriate:
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Total number of showing of interest statements signed and dated by employees in the proposed unit are: |
9.Is this petition accompanied by a showing of interest consisting of signed and dated statements from 30% or more of the employees in the proposed unit indicating that they desire to be represented for purposes of
collective bargaining by the petitioning employee organization? |
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YES |
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NO |
10.NAME OF CURRENTLY CERTIFIED BARGAINING AGENT for any of the employees in the proposed unit (if none, so state):
NAME OF UNION:
CERTIFICATION NUMBER:
Bargaining Agent (Union Representative):
Phone No. |
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Facsimile(Fax) No. |
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Address: |
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11. Is there an existing collective bargaining contract? |
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YES |
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NO |
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IF YES, date of expiration |
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I have read the above petition and all attachments. The statements contained therein are true to the best of my knowledge and belief. A copy of this fully executed form has been mailed or delivered to the other parties listed in items 5 and 10.
12.DATE OF EXECUTION:
Signature of Petitioner Representative
FALSE STATEMENTS MAY RESULT IN FINE AND IMPRISONMENT
PURSUANT TO CHAPTER 837, FLORIDA STATUTES
PERC Form 4
Page 2 of 2 (Rev. 6/07)