FORM NLRB-501 (2-18)Please Review the Following Important InformationBefore Filling Out a Charge Form!• Please call an Information Officer in the Regional Office nearest you for assistance in filing a charge. The Information Officer will be happy to answer your questions about the charge form or to draft the charge on your behalf. Seeking assistance from an Information Officer may help you to avoid having the processing of your charge delayed or your charge dismissed because of mistakes made in completing the form.• Please be advised that not every workplace action that you may view as unfair constitutes an unfair labor practice within the jurisdiction of the National Labor Relations Act (NLRA). Please click on the Help Desk button for more information on matters covered by the NLRA.• The section of the charge form called, “Basis of Charge,” seeks only a brief description of the alleged unfair labor practice. You should NOT include a detailed recounting of the evidence in support of the charge or a list of the names and telephone numbers of witnesses.• After completing the charge form, be sure to sign and date the charge and mail or deliver the completed form to the appropriate Regional Office.• A charge should be filed with the Regional Office which has jurisdiction over the geographic area of the United States where the unfair labor practice occurred. For example, an unfair labor practice charge alleging that an employer unlawfully discharged an employee would usually be filed with the Regional Office having jurisdiction over the worksite where the employee was employed prior to his/her discharge. An Information Officer will be pleased toassist you in locating the appropriate Regional Office in which to file your charge.• The NLRB’s Rules and Regulations state that it is the responsibility of the individual, employer or union filing a charge to timely and properly serve a copy of the charge on the person, employer or union against whom such charge is made.• By statute, only charges filed and served within six (6) months of the date of the event or conduct, which is the subject of that charge, will be processed by the NLRB.FORM NLRB-501 (2-18)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. 1. EMPLOYER AGAINST WHOM CHARGE IS BROUGHT a. Name of Employer b. Tel. No. 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 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) of the National Labor Relations Act, and thest unfair labor practices are practices affecting commerce within the meaning of the Act, or these unfair labor 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) 4b. Tel. No. 4c. Cell No. 4d. Fax No. 4e. e-mail 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. (signature of representative or person making charge) (Print/type name and title or office, if any) Address Date Tel. No. Office, if any, Cell No. Fax No. e-mail WILLFUL FALSE STATEMENTS ON THIS CHARGE CAN BE PUNISHED BY FINE AND IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001) PRIVACY ACT STATEMENTSolicitation 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 National Labor Relations Board (NLRB) in processing unfair labor practice and related proceedings or litigation. The routine uses for the information are fully set forth in 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 may cause the NLRB to decline to invoke its processes.