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DocuSign Envelope ID:6C22EOA0-1 EAC-4213-B3FA-734B66120F53 <br /> 6.1.J. - Page 12 <br /> APPENDIX A <br /> STATEMENT OF NON-DISPLACEMENT AND UNION CONSENT <br /> I. Statement of Non-Displacement <br /> As a representative of a Partner Organization of Public Allies, I acknowledge that my <br /> organization is not displacing an employee or position, nor reducing hours, wages or <br /> employee benefits as a result of hosting any Public Allies AmeriCorps member/s. <br /> Signature of Partner Organization Representative Date <br /> H77 <br /> II. Statement of Union Consent <br /> Federal regulations state that wherever AmeriCorps members are serving in <br /> organizations where they are performing job functions that are substantially similar to <br /> those of employees represented by a labor union, union consent is required in order for <br /> the organization to host the AmeriCorps member. <br /> (Check One): <br /> ❑ Not applicable. My organization either does not have unionized employees, or is <br /> hosting a Public Allies AmeriCorps member performing job functions substantially <br /> dissimilar from those carried out by unionized employees in my organization. <br /> (OR) <br /> ❑ Applicable. My organization is hosting a Public Allies AmeriCorps member <br /> performing job functions substantially similar to those performed by unionized <br /> employees. Written consent from the labor union has been offered in support of the <br /> organization hosting an AmeriCorps member. <br /> Signature of Partner Organization Representative Date <br /> Public Allies Partner Organization Agreement 2012-2013 10 <br /> ATTY/AGR/2012.117/PUBLICALLIES RWC2012-2013 <br /> REV:08-29-12 PT <br />