Fillable Pouring-permit-2015 City of Johns Creek Employee Pouring Permit Packet

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Pouring-permit-2015 City of Johns Creek Employee Pouring Permit Packet

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The Pouring-permit-2015 City of Johns Creek Employee Pouring Permit Packet form is 2 pages long and contains:

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  • 17 check-boxes
  • 59 other fields

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File type: PDF

U.S.A. forms for City of Johns Creek

BROWSE CITY OF JOHNS CREEK (GA) FORMS

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R156 (12/12/14)
Alcohol Employee Pouring Permit Application
APPLICATIONS MUST BE COMPLETED IN FULL AND SUBMITTED TO THE REVENUE DIVISION IN PERSON BETWEEN THE HOURS OF 8:30 AM AND 5:00
PM, MONDAY THROUGH FRIDAY. SUBMIT THE COMPLETED APPLICATION WITH A GOVERNMENT-ISSUED PICTURE I.D. AND NON-REFUNDABLE
PAYMENT IN THE AMOUNT OF $30.00.
I. Applicant Name: Social Security Number: - -
Last Name First Name MI
Gender: (Check One) Male or Female Maiden, Married, Alias or Other Names Used:
Date of Birth: / / Driver’s License Number: State Issued:
Race: Birthplace: (City, State & Country)
Are you a citizen of the United States or an alien lawfully admitted for permanent residence? (Check One) Yes or No
Phone: Email Address:
(Check One) Mobile or Home
II. Address Information – List your current home address and mailing address if necessary.
Current Address: Apartment/Unit:
City: State: Zip Code: Period: (mm/yy) / to /
Mailing Address: Apartment/Unit:
City: State: Zip Code: Period: (mm/yy) / to /
III. Have you been convicted for a misdemeanor or felony within the past five (5) years?
A guilty plea, plea of nolo contendere or the forfeiture of a bond is considered a conviction.
(Check One) Yes or No If yes, please explain below:
IV. Restaurant/Establishment Name:
V. Alcohol Awareness Training
As an applicant for an employee pouring permit, you must complete an approved alcohol awareness training program within 30
days of being issued a pouring permit or being employed. Details on approved programs will be provided by the City at the time
of submittal or can be found on the City’s website at www.johnscreekga.gov.
VI. Background Consent
I, (print your name) , authorize the City of Johns Creek and/or their
designee, Business Consulting & Investigations, Inc. (BCI), to make an independent investigation of my background, criminal or
police records.
I release the City of Johns Creek and any person or entity that provides information pursuant to this authorization, from any and
all liabilities, claims or lawsuits in regard to the information obtained from any and all of the above referenced sources used.
This consent form shall be valid as long as I am employed in the City of Johns Creek.
I hereby certify, under penalty of perjury, that statements made herein are to the best of my knowledge true and correct.
Applicant Signature: Date:
STAFF USE: Initials: _________ Amount Due: $30.00 Amount Paid: __________ Receipt #: ______________ __
Application Type (Circle): NEW RENEWAL SAVE Affidavit On File:
City of Johns Creek
Revenue
11360 Lakefield Drive
Johns Creek, Georgia 30097
(678) 512-3242
www.johnscreekga.gov
click to sign
signature
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R113 (12/12/14)
Affidavit Verifying Lawful Presence
Within the United States
I, (print name) , swear or affirm under penalty
of perjury that (check one):
I am a United States citizen.
I am a legal permanent resident of the United States.
I am a qualified alien or nonimmigrant under the Federal Immigration and
Nationality Act 18 years of age or older lawfully present in the United States.
Alien Registration Number:
I am applying for the following public benefit (check one):
Alcoholic Beverage License for
Print Business Name
Alcohol Employee Pouring Permit
Occupation Tax Certificate
Print Business Name
Door-to-Door Salesmen/Solicitors Permit
Other:
Public Benefit Name of Business (if applicable)
I understand that this sworn statement is required by law because I have applied for a public benefit. I
understand that state law requires me to provide proof that I am lawfully present in the United States prior
to receipt of this public benefit. I further acknowledge that knowingly and willfully making a false,
fictitious, or fraudulent statement of representation in this affidavit shall be guilty of a violation of Code
Section 16-10-20 of the Official Code of Georgia.
Print Name of Applicant Position Title (if applicable)
Signature of Applicant Date
Subscribed and sworn to before me on
the day of , 20 .
(Clerk/Notary Public)
My commission expires: __________________
City of Johns Creek
Revenue
11360 Lakefield Drive
Johns Creek, Georgia
30097 (678) 512-3242
www.johnscreekga.gov
click to sign
signature
click to edit
APPROVED ALCOHOL AWARENESS
TRAINING PROGRAMS
Training Institute for Responsible Vendors http://www.tirv.net/
TIPS http://gettips.com/
ServSafe http://www.servsafe.com/home
Evindi – RAS http://evindi.com/
Bloomin’ Brands http://bloominbrands.com/home/index.aspx
Learn2Serve http://www.learn2serve.com/
Communicata Language Services LLC
Darden Restaurants Responsible Alcohol Service Training Online
Rules and Regulations
Chapter 6, “Sec. 6-21(c). – Alcohol awareness training certification.
c. Every applicant to whom a pouring permit is issued and every employee who dispenses, sells, serves,
takes orders or mixes beverages shall also complete an approved alcohol awareness training program
within 30 days of being issued a pouring permit or being employed.” Each establishment shall maintain
an updated list of employees who have completed an approved alcohol awareness training program along
with copies of each of the employee’s completion certificate, and shall produce said list and/or certificates
for inspection by the city upon request.
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Pouring-permit-2015 City of Johns Creek Employee Pouring Permit Packet

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Completed 13 July 2020

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