Bartender’s requirements: Age 18, a person of good moral character, reputation, and fitness.

 

Instructions: Please fill out with ball point pen. THIS APPLICATION MUST BE SIGNED.

 

LAST NAME                          FIRST                      MA

ADDRESS                                        CITY                                                 PHONE #

GIVE OTHER ADDRESS, CITIES, STATES RESIDED IN FOR THE PAST 3 YEARS

 

DATE OF BIRTH                                      AGE                  MARRIED     SINGLE      .          DIVORCED     WIDOW     SEPARTED       .    

DRIVERS LICENSE #              STATE                                  SOCIAL SECURITY #

 

WHERE DO YOU PLAN TO WORK?

 

HAVE YOU EVER BEEN ARRESTED, INDICTED FOR OR CONVICTED OF ANY VIOLATION OF THE LAW, INCUDING TRAFFIC VIOLATIONS (MOVING VIOLATIONS ONLY)       YES       NO

 

IF YES, EXPLAIN WHAT FOR, WHEN, WHERE, AND THE DISPOSITION: NOTE: RENEWAL APPLICANT, LIST ONLY THOSE VIOLATIONS COMMITTED SINCE LAST APPLICTION. LIST BELOW.

 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

I AUTHORIZE ANY POLICE AGENCY TO RELEASE TO THE TOWN OF DEWEY, PORTAGE COUNTY, WISCONSIN ANY CRIMINAL HISTORY THAT I MAY HAVE. THIS AUTHORIZATION IS IN CONJUCTION WITH MY APPLICATION, FOR AN OPERATORS LICENSE.

 

 

 

SIGNED                                                                           DATED