Fillable How to apply for a new Managers Certificate (Gore District Council New Zealand)

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How to apply for a new Managers Certificate (Gore District Council New Zealand)

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Page 1
How to apply for a new
Manager’s Certificate
Under Section 219 of the Sale and Supply of Alcohol Act 2012
Follow the instructions below to apply for a manager’s certificate which authorises the
holder to manager any licensed premises.
Check you qualify to apply first
To hold a manager’s certificate you must:
be 20 years or older
have a Licence Controller Qualification (LCQ) certificate
be working or intend to be working in a licensed premises
have at least 6 months experience supervising licensed premises in New Zealand
What you need to do next
To apply for a new manager’s certificate, you need to:
supply the documents listed in the ‘What to include’ section on this page
pay the application fee of $316.25
answer all the questions in the form that apply to you
attend an interview with an alcohol licensing inspector (after we receive your form, we
will contact you to arrange a time)
How to submit your application
Choose any one of the following ways to submit your application:
Email application to alcohol@goredc.govt.nz
Drop off your application at 29 Bowler Avenue, Gore 9710
Post your application to PO Box 8, Gore 9740
How to get LCQ certification
If you don’t have an LCQ certificate
Find out how to get an LCQ certificate at serviceiq.org.nz/lcq/license-controller-qualification
If you have an LCQ certificate, check it is up to date
If your LCQ certificate stated ‘Sale and Supply of Alcohol Act 2012’ on it, your certificate is
up to date.
Page 2
What to include
You must supply all the documents listed below. We will send your application back if any
of these are missing.
The complete application form
A copy of your photo identification
A copy of your LCQ certificate
A letter from your employer or club, confirming that you are or will be employed there
Two references, one industry related and one character reference
Paying your fee
You must pay the fee of $316.25 (including GST). This fee is not refundable or transferable.
Payment options
By mail
Send your cheque and the application form to:
Gore District Council
PO Box 8
Gore 9740
In person
You can pay by cash, cheque, eftpos or credit card (credit card payments incur a surcharge)
Gore District Council
29 Bowler Avenue
Gore 9710
Electronic banking
Bank account 03 0915 0289519 00 – using reference MC followed by your name
Email your application and supporting documentation to:
alcohol@goredc.govt.nz
Form 17
Application for a new
Manager’s Certificate
Section 219, Sale and Supply of Alcohol Act 2012
To: The Secretary
District Licensing Committee
Gore District Council
PO Box 8
Gore 9710
03 209 0330
Application for a manager’s certificate is made in accordance with the details set out below:
Details of applicant
Male Female
Full legal name
Maiden / previous name or any alias:
Usual address:
Date of birth:
Contact number:
Email address:
Do you have any convictions? Yes No
If yes, please give details:
Employment details
Do you intend to be the manager of any particular licensed premises? Yes No
Current place of employment:
Details of position you hold:
Name of licensed premises you are working at:
How long have you worked at this premises?
Work visa status: Yes No N/A
If yes, you must supply a copy of your visa with this application.
Office Use Only
Area Office Stamp
Application forwarded to:
Police Response received Y N
Inspector Response received Y N
Payment:
Cash Chq Eftpos DD CtCd
Paid by: Applicant Other __________
Date Paid:
Receipt Number:
If you work in a club are you employed or a volunteer? Employed Volunteer
What is your current role at the club?
What management or other activities are you involved with at the licensed premises?
List the activities or write ‘none’
Training and Experience Details
Have you ever held a manager’s certificate in the past? Yes No
If yes, provide details of dates and where it was issued:
Have you had any relevant and recent training? Yes No
Relevant training includes the LCQ and on-the-job training. Recent means within the last 18 months.
Date of training
Training course or type of on-the-job training
Training provider or place
Do you hold the Licence Controller Qualification or a prescribed qualification within the meaning
of section 218 of the Sale and Supply of Alcohol Act 2012?
Yes
No (you need an up-to-date LCQ certificate before you can apply)
If yes, on what date was the qualification obtained?
Have you had any recent experience managing a licensed premises? Yes No
Recent means within the last 18 months.
Date of training
Type of experience
Name of licensed premises
What steps do you intend to take to manage the sale and supply of alcohol pursuant to the licence
with the aim of contributing to the reduction of alcohol-related harm?
Signature of Applicant:
Date:
Please attach the following:
Character reference.
Reference (written) from current employer or club committee confirming position/duties and any need for
certificate.
Evidence to support experience claimed in the alcohol industry, e.g. detailed references from employers, or an
affidavit.
Licence Controller Qualification (LCQ) and any Bridging Test certificate if appropriate.
Evidence to support any training/qualification claimed.
Photographic identification e.g. drivers licence or passport.
If applicable, copy of Visa.
Overseas residents seeking work in New Zealand should provide a copy of their passport details.
The fee of $316.25.
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Completed 15 November 2020

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