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Get DoL NLRB-501 2008

FORM EXEMPT UNDER 44 U.S.C 3512 INTERNET FORM NLRB-501 2-08 UNITED STATES OF AMERICA NATIONAL LABOR RELATIONS BOARD CHARGE AGAINST EMPLOYER DO NOT WRITE IN THIS SPACE Case Date Filed INSTRUCTIONS File an original with NLRB Regional Director for the region in which the alleged unfair labor practice occurred or is occurring. DECLARATION I declare that I have read the above charge and that the statements are true to the best of my knowledge and belief. Office if any Cell No. By signature of representative or person making charge Print/type name and title or office if any date Address WILLFUL FALSE STATEMENTS ON THIS CHARGE CAN BE PUNISHED BY FINE AND IMPRISONMENT U.S. CODE TITLE 18 SECTION 1001 PRIVACY ACT STATEMENT Solicitation of the information on this form is authorized by the National Labor Relations Act NLRA 29 U.S.C. 151 et seq. The principal use of the information is to assist the Federal Register 71 Fed. Reg. 74942-43 Dec. 13 2006. The NLRB will further explain these uses upon request. Disclosure of this information to the NLRB is voluntary however failure to supply the information will cause the NLRB to decline to invoke its processes. 1. EMPLOYER AGAINST WHOM CHARGE IS BROUGHT b. Tel* No* a* Name of Employer c* Cell No* f* Fax No* d. Address Street city state and ZIP code e. Employer Representative g. e-Mail h. Number of workers employed i. Type of Establishment factory mine wholesaler etc* j. Identify principal product or service k. The above-named employer has engaged in and is engaging in unfair labor practices within the meaning of section 8 a subsections 1 and list subsections g of the National Labor Relations Act and these unfair labor practices are practices affecting commerce within the meaning of the Act or these unfair labor practices are unfair practices affecting commerce within the meaning of the Act and the Postal Reorganization Act. 2. Basis of the Charge set forth a clear and concise statement of the facts constituting the alleged unfair labor practices 3. Full name of party filing charge if labor organization give full name including local name and number 4a* Address Street and number city state and ZIP code 4d. Fax No* 5. Full name of national or international labor organization of which it is an affiliate or constituent unit to be filled in when charge is filed by a labor organization 6. DECLARATION I declare that I have read the above charge and that the statements are true to the best of my knowledge and belief* Office if any Cell No* By signature of representative or person making charge Print/type name and title or office if any date Address WILLFUL FALSE STATEMENTS ON THIS CHARGE CAN BE PUNISHED BY FINE AND IMPRISONMENT U*S* CODE TITLE 18 SECTION 1001 PRIVACY ACT STATEMENT Solicitation of the information on this form is authorized by the National Labor Relations Act NLRA 29 U*S*C. 151 et seq. The principal use of the information is to assist the Federal Register 71 Fed* Reg* 74942-43 Dec* 13 2006. The NLRB will further explain these uses upon request. Disclosure of this information to the NLRB is voluntary however failure to supply the information will cause the NLRB to decline to invoke its processes. .

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