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2021 Operator (Bartender) License Application (includes provisional)

2. Two Year Operator (Bartender) License Application*

   1. New ($50.00)
   2. Renewal ($50.00)
   3. Temporary ($10.00)

   Please note any background result information that would otherwise result in a rejection of the application is sent to the person named on the application - meaning, if your employer applies for you - they may be privvy to your background check information. Licenses are not employer specific and can be used at any establishment in the Village.

3. Applicant's Checklist

   1. - Complete this application
   2. - Upload copy of Driver License
   3. - Fee (to be paid by mail or in person - cash or check only)***
   4. - Responsible Beverage Court Completion OR License from another municipality

   *** FEE MUST BE RECEIVED PRIOR TO LICENSE BEING GRANTED.

5. First Name*

6. Middle Name*

7. Last Name*

9. Date of Birth*

10. Phone Number*

11. Place of Employment*

13. Street Address*

    No PO Box numbers

15. City*

16. State*

17. Zip Code*

19. Driver License Number*

20. Copy of Current Driver License*

    You must include an upload of your Driver License.

22. Email Address*

    You must include an email address. Your license will be sent to your email. This will allow you to provide the license to whomever you need any time you need.

23. Manager Email

    If you would like a copy also sent to your manager, please include their email here. This is not required.

25. Have you Completed and Passed the Wisconsin Responsible Beverage Server Training Course?*

    1. Yes, please attach the Certificate.
    2. Yes, I already have a license which I will provide below and do not need to submit the class certificate.
    3. No, visit http://www.learn2serve.com/wisconsin-beverage-server/
    4. This is a temporary license.

    The Server's Training Course is NOT required for Temporary License Applicants.

26. If yes, upload a copy of your Responsible Beverage Documentation.

28. Have you ever been issued an Operator's License before?*

    1. No
    2. Yes

29. If yes, where?

30. When?

    Enter the approximate start date of your license.

31. Upload a copy of your license.

33. Required*

    1. I have read and understand the Department of Revenue Operator License Brochure.

34. Department of Revenue Operator License Brochure
    https://www.revenue.wi.gov/DOR%20Publications/3104OperatorsLicenses.pdf

    Please review. If you need to complete the online beverage service courses, a list is provided through the brochure.

36. Has your license ever been any of the following?*

    1. Revoked
    2. Denied
    3. Withdrawn
    4. Suspended
    5. None of the Above

37. If any are checked, give date(s) and place(s) where occurred:

    Date/Municipality

39. Is this part of an event?*

    1. No
    2. Yes

40. If yes, what event?

41. Event Date

43. Acknowledgement
    I, the undersigned, do hereby respectfully make application to the local governing body of the Village of Elm Grove, County of Waukesha, Wisconsin, for an "Operator's" license as provided by Section 125.17 of the Wisconsin Statutes, for the licensing year ending June 30 each year. I certify that I am eighteen years of age or older. I am familiar with the laws, ordinances and regulations and I hereby agree if granted said license, to obey all provisions of said laws. I understand that all of my answers on this information sheet will be considered in connection with my license applications. I also understand that all answers herein are made under oath, and that false swearing is a crime as defined in Section 939.12 of the Wisconsin Statutes. Licenses may be revoked by the Village if the licensee violates the law or if he or she fails to comply with state statutes or city ordinances, or if any answers contained in the application or in this information sheet are false. I understand incomplete and incorrect information may lead to the denial of this license.

    I, the undersigned, do hereby respectfully make application to the local governing body of the Village of Elm Grove, County of Waukesha, Wisconsin, for an "Operator's" license as provided by Section 125.17 of the Wisconsin Statutes, for the licensing year ending June 30 each year. I certify that I am eighteen years of age or older. I am familiar with the laws, ordinances and regulations and I hereby agree if granted said license, to obey all provisions of said laws. I understand that all of my answers on this information sheet will be considered in connection with my license applications. I also understand that all answers herein are made under oath, and that false swearing is a crime as defined in Section 939.12 of the Wisconsin Statutes. Licenses may be revoked by the Village if the licensee violates the law or if he or she fails to comply with state statutes or city ordinances, or if any answers contained in the application or in this information sheet are false. I understand incomplete and incorrect information may lead to the denial of this license.

45. By Submitting this form, you have read and understand the information in this application and will adhere to all rules and regulations set forth by the Village of Elm Grove and the State of Wisconsin. You also understand your license can be withdrawn for any violation by the Village of Elm Grove or the State of Wisconsin.

    By Submitting this form, you have read and understand the information in this application and will adhere to all rules and regulations set forth by the Village of Elm Grove and the State of Wisconsin. You also understand your license can be withdrawn for any violation by the Village of Elm Grove or the State of Wisconsin.

47. Elm Grove Municipal Code Link
    https://ecode360.com/8135785

Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field