Local Licensing
Authority Application
9500 Civic Center Drive, Thornton, CO 80229 303-538-7230
Local Licensing Authority
The Local Licensing Authority has several functions including conducting hearings and making findings of fact on
whether to grant or deny a local liquor license, and reviewing alleged liquor and beer violations. The Authority also
considers applications for manager registration, change of location, transfer of ownership, change in corporate
structure, and request to modify the premises. Chapter 42, Article II, of the City Code has delegated approval of some
of these applications, under certain circumstances, to City staff.
Board Membership and Qualifications
Membership consists of nine members. Members must be at least twenty-one years of age and represent and reflect
the conscience of the community. Meetings are held the third Wednesday of each month and normally begin at 6:00
Name of Applicant (First, Middle, Last (include Sr., Jr., etc.) Ward No.
Home Address (include City, State ZIP+4)
Phone Number: Alternate Phone Number:
1. Do you have relatives presently working for the City of Thornton? Yes No If yes, please list.
Tell us briefly what specific talents, expertise, experience, previous civic activities, and/or volunteer service you would bring to
this board if appointed.
3. The Colorado Supreme Court issued a ruling that a denial of a license cannot be based on abhorrence to alcohol
for personal or religious reasons. Do you have any personal or religious objections to the use of alcoholic
Yes No
4. City Code Section 42-57(g) states that no person can serve or continue to serve on the Local Licensing Authority
if they or an immediate family member has a financial interest in any business holding a Liquor or Beer License
under State Statute. Have you ever had a financial interest (direct or indirect) in a liquor/beer licensed
establishment? If yes, please give name of establishment(s) and relationship (e.g., owner, stockholder, etc.)
Yes No
5. Are you currently involved with this establishment? Yes No
Local Licensing Authority
Page 2
Current Employer:
Address of Employer:
Please read the following, then type your name and date in the signature block below, and
electronically, using the “Submit by Email” button in order to complete the board application.
certify that the facts and statements contained in this board application are true and correct. I further understand
that false statements shall be sufficient cause for rejection of this application or for grounds to apply the penalty
provisions of the Code of Ethics.
I further certify that I have not been convicted of a felony under the laws of the State of Colorado or in another jurisdiction.
I understand that falsification, omission or misrepresentation will result in a rejection of this application. Any
falsification, omission or misrepresentation is evidence of perjury in the second degree.
I authorize the City of Thornton to conduct a criminal background investigation, with the understanding that any felony
convictions found will become a matter of public record. I further understand and acknowledge my rights under federal
privacy laws, including the Privacy Act of 1974, with respect to access and disclosure of information and hereby waive such
rights with the understanding that any and all information furnished will be used only in connection with contracting
Your typed name here Date
constitutes your signature.
Continued on next page.
S:\CLERK\Boards, Commissions, and Council\Applications\Background Forms\FCRA Disclosure and Authorization 01.01.2013.docx Revised 1/1/2013
As an applicant for employment or a current employee of the City of Thornton, you are a consumer with rights under the
Fair Credit Reporting Act. When any of the following circumstances exist, the City of Thornton may choose to obtain and
use information contained in either a consumer report or an investigative consumer report from a consumer reporting
agency about you when: (1) considering your application for employment, (2) making a decision whether to offer you
employment, (3) deciding whether to continue your employment (if you are hired), or (4) making other employment-related
decisions directly affecting you.
For explanation purposes, a “consumer reporting agency” is a person or business which, for monetary fees, dues, or on a
cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on
consumers for the purpose of furnishing consumer reports to others, such as the City of Thornton.
A “consumer report” means any written, oral or other communication of any information by a consumer reporting agency
bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics,
or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a
factor in establishing your eligibility for employment purposes.
An “investigative consumer report” means a consumer report or portion thereof in which information on your character,
general reputation, personal characteristics, or mode of living is obtained through personal interviews with your neighbors,
friends, associates or others with whom you are acquainted or who may have knowledge concerning any such items of
In the event an investigative consumer report is prepared, you may request, additional disclosures regarding the nature
and scope of the investigation requested as well as a written summary of your rights under the Fair Credit Reporting Act.
By signing below, I, , hereby voluntarily authorize the City of Thornton to
obtain either a consumer report or an investigative consumer report about me from a consumer reporting agency and to
consider this information when making decisions regarding my employment at the City of Thornton.
I understand that I have rights under the Fair Credit Reporting Act, including the rights discussed above. In accordance
with the Fair Credit Reporting Act, if my employment is denied, based on information contained in a consumer report or
investigative consumer report from a consumer reporting agency, the City of Thornton will so advise me and will supply
the name and address of the consumer reporting agency making the report.
If I am employed by the City of Thornton this authorization shall remain in effect as long as I am an employee.
I acknowledge that I have received and read this Fair Credit Reporting Act Disclosure and Written Authorization
Signature Date
We (I) hereby grant consent to the City of Thornton to conduct a consumer report or an investigative consumer report on
the above named individual as a part of the job application process and thereafter as warranted based on City of Thornton
policy in the event the above named individual is employed by the City.
Parent or legal guardian's signature Date
Parent or legal guardian's name (Please Print)
Submit by emailSubmit by email
click to sign
click to edit
click to sign
click to edit
Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la
Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and
privacy of information in the files of consumer reporting agencies. There are many types of
consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies
that sell information about check writing histories, medical records, and rental history records).
Here is a summary of your major rights under FCRA. For more information, including
information about additional rights, go to www.consumerfinance.gov/learnmore or write
to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
You must be told if information in your file has been used against you. Anyone who
uses a credit report or another type of consumer report to deny your application for credit,
insurance, or employment or to take another adverse action against you must tell you,
and must give you the name, address, and phone number of the agency that provided the
You have the right to know what is in your file. You may request and obtain all the
information about you in the files of a consumer reporting agency (your “file
disclosure”). You will be required to provide proper identification, which may include
your Social Security number. In many cases, the disclosure will be free. You are entitled
to a free file disclosure if:
o a person has taken adverse action against you because of information in your
credit report;
o you are the victim of identity theft and place a fraud alert in your file;
o your file contains inaccurate information as a result of fraud;
o you are on public assistance;
o you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon
request from each nationwide credit bureau and from nationwide specialty consumer
reporting agencies. See www.consumerfinance.gov/learnmore for additional
You have the right to ask for a credit score. Credit scores are numerical summaries of
your credit-worthiness based on information from credit bureaus. You may request a
credit score from consumer reporting agencies that create scores or distribute scores used
in residential real property loans, but you will have to pay for it. In some mortgage
transactions, you will receive credit score information for free from the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify
information in your file that is incomplete or inaccurate, and report it to the consumer
reporting agency, the agency must investigate unless your dispute is frivolous. See
www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete, or
unverifiable information. Inaccurate, incomplete, or unverifiable information must be
removed or corrected, usually within 30 days. However, a consumer reporting agency
may continue to report information it has verified as accurate.
Consumer reporting agencies may not report outdated negative information. In
most cases, a consumer reporting agency may not report negative information that is
more than seven years old, or bankruptcies that are more than 10 years old.
Access to your file is limited. A consumer reporting agency may provide information
about you only to people with a valid need usually to consider an application with a
creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a
valid need for access.
You must give your consent for reports to be provided to employers. A consumer
reporting agency may not give out information about you to your employer, or a potential
employer, without your written consent given to the employer. Written consent generally
is not required in the trucking industry. For more information, go to
You may limit “prescreened” offers of credit and insurance you get based on
information in your credit report. Unsolicited “prescreened” offers for credit and
insurance must include a toll-free phone number you can call if you choose to remove
your name and address form the lists these offers are based on. You may opt out with the
nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
The following FCRA right applies with respect to nationwide consumer reporting
You have a right to place a “security freeze on your credit report, which will
prohibit a consumer reporting agency from releasing information in your credit
report without your express authorization. The security freeze is designed to prevent
credit, loans, and services from being approved in your name without your consent.
However, you should be aware that using a security freeze to take control over who gets
access to the personal and financial information in your credit report may delay, interfere
with, or prohibit the timely approval of any subsequent request or application you make
regarding a new loan, credit, mortgage, or any other account involving the extension of
As an alternative to a security freeze, you have the right to place an initial or extended
fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is
placed on a consumer’s credit file. Upon seeing a fraud alert display on a consumer’s
credit file, a business is required to take steps to verify the consumer’s identity before
extending new credit. If you are a victim of identity theft, you are entitled to an extended
fraud alert, which is a fraud alert lasting 7 years.
A security freeze does not apply to a person or entity, or its affiliates, or collection
agencies acting on behalf of the person or entity, with which you have an existing
account that requests information in your credit report for the purposes of reviewing or
collecting the account. Reviewing the account includes activities related to account
maintenance, monitoring, credit line increases, and account upgrades and enhancements.
You may seek damages from violators. If a consumer reporting agency, or, in some
cases, a user of consumer reports or a furnisher of information to a consumer reporting
agency violates the FCRA, you may be able to sue in state or federal court.
Identity theft victims and active duty military personnel have additional rights. For
more information, visit www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws.
In some cases, you may have more rights under state law. For more information, contact
your state or local consumer protection agency or your state Attorney General. For
information about your federal rights, contact:
a. Consumer Financial Protection Bureau
1700 G Street, N.W.
Washington, DC 20552
b. Federal Trade Commission
Consumer Response Center
600 Pennsylvania Avenue, N.W.
Washington, DC 20580
(877) 382-4357
a. Office of the Comptroller of the Currency
Customer Assistance Group
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050
b. Federal Reserve Consumer Help Center
P.O. Box 1200
Minneapolis, MN 55480
c. FDIC Consumer Response Center
1100 Walnut Street, Box #11
Kansas City, MO 64106
d. National Credit Union Administration
Office of Consumer Financial Protection (OCFP)
Division of Consumer Compliance Policy and Outreach
1775 Duke Street
Alexandria, VA 22314
Asst. General Counsel for Aviation Enforcement & Proceedings
Aviation Consumer Protection Division
Department of Transportation
1200 New Jersey Avenue, S.E.
Washington, DC 20590
Office of Proceedings, Surface Transportation Board
Department of Transportation
395 E Street, S.W.
Washington, DC 20423
Nearest Packers and Stockyards Administration area supervisor
Associate Deputy Administrator for Capital Access
United States Small Business Administration
409 Third Street, S.W., Suite 8200
Washington, DC 20416
Securities and Exchange Commission
100 F Street, N.E.
Washington, DC 20549
Farm Credit Administration
1501 Farm Credit Drive
McLean, VA 22102-5090
Federal Trade Commission
Consumer Response Center
600 Pennsylvania Avenue, N.W.
Washington, DC 20580
(877) 382-4357