Labor Dispute Questionnaire (Employer)
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Employer Illinois Department of Employment Security 33 South State Street * Chicago, Illinois 60603 LABOR DISPUTE QUESTIONNAIRE 1. Employer: Name Address Phone No. Administrative office where records are maintained Location(s) Plant(s) or job site(s) of labor dispute, if other than above. 2. Union: Title and Local No. Name and Title of Official Address Phone No. On separate sheets list additional union(s), if any, directly involved. Also list separately union(s) not directly involved. In both instances give job classification of workers they represent. 3. Nature of business 4. (a) There is no labor dispute strike on and/or (b) An interruption of work began because of a lockout on in a disagreement over: 5. Job classifications of workers represented by the union directly involved in the labor dispute: 6. (a) Normal number of workers (b) Number of workers unemployed because of the strike at plant or job site________________________________ or lockout 7. Extent of curtailment in operations (manufacturing, volume or sales, etc,) % 8. (a) Not settled as of (b) Labor dispute settled on (c) Interruption of work ceased, pro- ductive operations resumed on (d) If there was a delay between the date of settlement of the labor dispute and the date of resumption of productive oper- ations, give reasons for the delay: (Continued on reverse side) Ben-178A (9-91) 9. (a) Was there picketing? By Whom? How long? (b) Was there force, violence, or other obstructive activities on the picket line? Describe such activity: ********** 10. IMPORTANT, PLEASE NOTE: (a) Do you employ any workers who are NOT members of the union directly involved in the Labor Dispute? yes no (b) If yes what are their job classifications? (c) Did any of these workers refuse or fail to work? Reasons given by them, if any, for such failure to work. (d) Did they involve themselves in the labor dispute or strike activities, other than by refusing to cross the picket lines? Please give specific facts or evidence. (e) Could work have been provided for these workers in the absence of the workers directly involved in the dispute? If so for how long? (f) Were any of these workers laid off? If so when? (g) Please give the job classifications of any workers laid off: 11. Did any workers continue in employment during this period? If so, what were their job classifications? ********** NOTE: Use additional sheets of paper if the spaces provided on this form are not sufficient to give all of the pertinent information. A copy of the labor management agreement will be appreciated. I certify that the information contained herein is true and correct. Date Signed Title ********** In addition to submitting this form, if you or any person designated by you has knowledge of the facts, wish to present additional facts to the Claims Adjudicator in person, please check the box below. Your failure to request this opportunity will not affect any established right you may have to file an appeal from any determination with which you may disagree. I wish to present additional facts to the Claims Adjudicator. Arrangements will be made for interviews in Chicago regarding labor disputes in the Chicago Metropolitan Area or at one of our downstate offices for those outside of such area, or at a location mutually agreeable.