BUREAU OF MEDIATION SERVICES PETITION FOR MEDIATION SERVICES WWWBMSSTATEMNUS

EXECUTIVE OFFICEDIVISION NAME BUREAUDISTRICT OR SECTION NAME PO
9 CMDT9835F UNION INTERNATIONALE DES TÉLÉCOMMUNICATIONS BUREAU
TUSCARAWAS COUNTY FARM BUREAU 2146 EAST HIGH

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 029 BUREAU
02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 031 BUREAU
1 LE PROTOCOLE S’APPLIQUE POUR LES SERVICES COURANTS (BUREAUX

PETITION FOR MEDIATION SERVICES

Bureau of Mediation Services PETITION FOR MEDIATION SERVICES www.bms.state.mn.us

State of Minnesota (PUBLIC SECTOR) Phone: 651-649-5421

1380 Energy Lane, Suite 2 Fax: 651-643-3013

St. Paul, MN 55108-5253

Case No. ____________________

Name of Petitioning Organization ______________________________________________________________________________________

Address ______________________________________________________________________________ Phone _____________________

Name of Chief Negotiator/Contact______________________________________________________________________________

Address ______________________________________________________________________ Phone _____________________

E-Mail Address ____________________________________________________________________________________________

Name of 2^nd Contact (if applicable) _____________________________________________________________________________

Address ______________________________________________________________________ Phone _____________________

E-Mail Address ____________________________________________________________________________________________

Name of Other Party ________________________________________________________________________________________________

Address ______________________________________________________________________________ Phone _____________________

Name of Chief Negotiator/Contact______________________________________________________________________________

Address ______________________________________________________________________ Phone _____________________

E-Mail Address ____________________________________________________________________________________________

Name of 2^nd Contact (if applicable) _____________________________________________________________________________

Address ______________________________________________________________________ Phone _____________________

E-Mail Address ____________________________________________________________________________________________

List three dates and times petitioner is available for mediation: 1^st _________________ 2^nd_________________ 3^rd ________________

Type of Government Agency: ⁭ County ⁭ Municipality ⁭ School District ⁭ Spec Board/Commission ⁭ State ⁭ U of M

Type of Mediation Requested: ⁭ Contract ⁭ Grievance

Type of Bargaining Unit Involved: (file a separate petition for each appropriate unit) Check the ONE designation which is most appropriate.

⁭ K-12 Teachers ⁭ RN’s ⁭ Highway/Public Works/Parks

⁭ Police/Fire/Corrections ⁭ Clerical/Administrative ⁭ Technical

⁭ Supervisory ⁭ Social Services ⁭ Wall-to-Wall

⁭ Confidential ⁭ Maintenance & Trades ⁭ Other Professional

⁭ Principals/Asst.Principals ⁭ Service & Support ⁭ Other ____________________________

Status of Employees Involved: ⁭ Essential ⁭ Other Than Essential

Number of Employees in Unit: _____ Number of Prior Negotiating Meetings Held: _____ Date of 1^st Negotiating Meeting: _______________

Concise Statement of the Nature of This Dispute and Unresolved Issues: ______________________________________________________

________________________________________________________________________________________________________________

Date Current Contract Expires: ___________________________________________

Check if this is a First Contract ⁭ Check if this is a Mid Contract Re-opener ⁭

Date of Petition: _______________________

PETITIONER MUST SEND A COPY OF THIS PETITION TO THE OTHER PARTY.

Date Petitioner Sent Copy to Other Party Above: _______________________

x _______________________________________________

Authorized Signature

Completed petition may be faxed to 651-643-3013 ________________________________________________

(If petition is faxed – please do not mail the original) Title of Person Signing this Petition

6/08

10149 CHAPTER 5 BUREAU OF ELDER AND ADULT SERVICES
17 POLICY ANALYSIS AND BUREAUCRATIC CAPACITY CONTEXT COMPETENCIES AND
18 DEPARTMENT OF ADMINISTRATIVE AND FINANCIAL SERVICES 389 BUREAU

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