Fill and Sign the Notice of Results of Election Form

Basic form © James R. M cDade (rev: 01 -12-01) NOTICE OF RESULTS OF ELECTION Note: Employers us this form to report the result s of the AWS election to the State of California . Seek legal counsel if you do not know the wage and hour rules. (Delete this form prior to use.) TO: Division of Labor Stat istics and Research Attention: Alternative Workweek Election Results P.O. Box 420603 San Francisco, CA 94142 -0603 From: [Company Name] [Contact Person] [Company Address] [City, State, Zip] [Company Phone Number] 1. A written election by secret ballo t was conducted on ___________, 20___, for the employees in the [designated work unit] work unit at [company name] . (If the work unit consisted of only one person, then the ballot was in writing, but was not secret.) 2. The employees voted on the following a lternative work schedule [or menu of schedules]: ______________________________________________________________________ 3. Of the [number] employees in the work unit, [number] elected to institute an alternative workweek schedule, and [number] elected not to institute the alternative workweek schedule. Thus, of the total number of employees in the work unit (regardless of whether they voted or not), ____% elected to institute the alternative workweek schedule. 4. The following number of employees did not vote be cause they were absent: _____. 5. Based on the election, the alternative workweek schedule [was] [was not] instituted. Dated: _____________________ By: ________________________________ [Company Representative]