California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1.8 - Collective Bargaining Agreements Under Labor Code Sections 3201.5 and 3201.7 › Section 10202.1 - Petition for Permission to Negotiate a Section 3201.7 Labor-Management Agreement (DWC Form Rgs-1)

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
STATE OF CALIFORNIA
Department of Industrial Relations
Division of Workers' Compensation
Administrative Director
Post Office Box 420603
San Francisco, CA 94142-0603
Telephone: (415) 703-4600
Petition for Permission to Negotiate a Section
					 3201.7
					 Labor-Management Agreement
Labor Code §
										3201.7; Title
					 8, California Code of Regulations §
										10202
Please submit the following information to the
					 Administrative Director of the Division of Workers' Compensation to obtain a
					 letter advising the below-named union and employer, or group of employers, of
					 their eligibility to enter into negotiations for the purpose of reaching
					 agreement on a labor-management agreement authorized by Section
					 3201.7 of the California Labor
					 Code.
(Print or Type Name and Addresses)
1. Union Information
Name of Union:
Contact Person and Title:
Principal Address:
2. Employer Information (For group of
				  employers, please use separate pages to list all individual employers.)
Name of Employer:
Contact Person and Title:
Federal Employers Identification Number (FEIN):
Principal Business of Employer:
Principal Address:
3. Please describe the bargaining unit or
				  units to be covered by the Section
				  3201.7 labor-management agreement,
				  and provide the approximate number of employees in the unit(s).
4. Please attach proof of the union's status
				  as the exclusive bargaining representative of the employees in the
				  above-described bargaining unit(s).
5. Please attach a copy of the current
				  collective bargaining agreement or agreements in effect between the union and
				  the employer.
I declare under penalty of perjury under the laws of
					 the State of California that the foregoing is true and correct.
EXECUTED AT ______________________________(City),
					 CALIFORNIA ON ____________________(Date)
BY: ________________________________________(Original
					 Signature of Union Representative), TITLE:
					 ______________________________
You must attach a proof of service by mail
					 declaration indicating that the petition and all supporting evidence was mailed
					 to the employer, or for a group of employers, all individual
					 employers.
DWC Form RGS-1 (012004)
1. New
					 section filed 4-22-2004 as an emergency; operative 4-22-2004 (Register 2004,
					 No. 17). A Certificate of Compliance must be transmitted to OAL by 8-20-2004 or
					 emergency language will be repealed by operation of law on the following
					 day.
2. Certificate of Compliance as to 4-22-2004 order, including
					 further amendment of section, transmitted to OAL 8-20-2004 and filed 10-4-2004
					 (Register 2004, No. 41).
Note: Authority cited: Sections
						133 and
						5307.3, Labor
						Code. Reference: Section
						3201.7, Labor
						Code.