Operator (Bartender) License Application July 1, 2020 to June 30, 2021

2. OPERATOR (Bartender) LICENSE APPLICATION*

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

   Please note the license may take up to 30 days pending a background check. Background information is sent to whomever applies for the license - 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 City.

3. Fee
   $30.00 for regular establishments. $20.00 for non-profit entities. Fee includes a background check and is non-refundable and non-prorated. Make checks payable to the City of Delafield. License expires June 30th. No licenses will be issued after April 30th for the current year - applicant will be eligible for a July 1 license.

   $30.00 for regular establishments. $20.00 for non-profit entities. Fee includes a background check and is non-refundable and non-prorated. Make checks payable to the City of Delafield. License expires June 30th. No licenses will be issued after April 30th for the current year - applicant will be eligible for a July 1 license.

5. First Name*

6. Middle Name*

7. Last Name*

8. Date of Birth*
   Date of Birth

10. Street Address*

12. City*

13. State*

14. Zip*

16. Driver's License Number*

17. Copy of Current Driver's License*

    You must include an upload of your driver license.

19. Email Address*

    You must include an email address. No mailed licenses will be sent.

20. Manager Email

    If you would like a copy also sent to your manager, please include their email here.

21. Current Phone Number*

23. Name of Business*

24. Phone Number of Business*

25. Business Manager Name

27. 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.

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

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

    1. Yes
    2. No

31. If yes, which municipality?

32. When?
    When?

    Enter the start date of your license.

33. If yes, upload a copy of your license.

    You must include a copy of your license even if it is from the City of Delafield.

35. Required*

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

36. 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.

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

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 Withdrawn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

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

    Date/Municipality

41. Is this part of an event?

    1. No
    2. Yes

42. If yes, what event?

43. Event Date
    Event Date

45. Are you interested in having your name put on a list for non-profit work?

    1. Yes, please add me to the list.
    2. No

    In the summer time, the City of Delafield has many non-profits that hold events; such as the 4th of July parade, St Patty's Day party, National Night Out, etc. These non-profits are looking for people to work their events who already hold a license in the City of Delafield. Saying "Yes" would add your name to the list of people we hand out to non-profits when they need bartenders.

47. I, the undersigned, do hereby respectfully make application to the local governing body of the City of Delafield, 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 Common Council 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.

49. 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 City of Delafield and the State of Wiscosnin.
    You also understand your license can be withdrawn for any violation by the City of Delafield or the State of Wisconsin.

    You also understand your license can be withdrawn for any violation by the City of Delafield or the State of Wisconsin.

51. Municipal Code Section 125.17 Issuance of Operators license

55. Applicant's Checklist

    1. Complete and submit application.
    2. Upload copy of current Driver’s License.
    3. Fee - pay in person, online (a link will be available on the confirmation page), or check by mail
    4. Uploaded copy of Responsible Beverage Server Training Course Certificate of Completion. (Not required for Temporary)

Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field