Application For Special Permit Authorizing Employment Of Persons Under 18 Years Of Age
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Application For Special Permit Authorizing Employment Of Persons Under 18 Years Of Age Form. This is a New Jersey form and can be use in Division Of Alcoholic Beverage Control Statewide.
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Tags: Application For Special Permit Authorizing Employment Of Persons Under 18 Years Of Age, New Jersey Statewide, Division Of Alcoholic Beverage Control
STATE OF NEW JERSEY
DEPARTMENT OF LAW AND PUBLIC SAFETY
DIVISION OF ALCOHOLIC BEVERAGE CONTROL
P.O. BOX 087, 140 EAST FRONT STREET
TRENTON, NJ 08625-0087
APPLICATION FOR SPECIAL PERMIT AUTHORIZING EMPLOYMENT
OF PERSONS UNDER 18 YEARS OF AGE BY AN ALCOHOLIC
BEVERAGE LICENSEE [EMP]
This application must be accompanied by a fee of $15.00 in the form
of check or money order payable to the Division of A.B.C. New
applicants must also submit:
I.
One passport-size photograph (full face)taken within the last
30 days.
II.
A photocopy of applicant’s Employment Certificate (working
papers)issued by his/her District Board of Education.
CHECK ONE: NEW APPLICANT (
1.
)
RENEWAL APPLICANT (
)
Full Name of Applicant:_____________________________________
PLEASE PRINT CLEARLY OR TYPE
2.
Home Address of Applicant:__________________________________
STREET ADDRESS
________________________________________________________________________
CITY/TOWN
STATE
ZIP CODE
3.
Social Security Number__________-_______-__________
4.
Description of Applicant:
Age______________________
Male/Female_________
Date of Birth______/______/______
Hair Color__________
Eye Color________________
Height______________
Weight___________________
NOTE:
5.
Are you presently, or have you ever been under the supervision
of any parole or probation authority? If yes, you must attach a
copy of your court disposition or a letter from your parole
officer. YES (
)
NO (
)
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NOTE: BOTH SIDES OF THIS APPLICATION MUST BE FILLED OUT
IN IT=S ENTIRETY BEFORE A PERMIT IS ISSUED.
THIS AREA TO BE COMPLETED BY ALCOHOLIC BEVERAGE
LICENSEE. (EMPLOYER):
6.
Name of Licensee:___________________________________________
PLEASE PRINT CLEARLY OR TYPE
7.
Address of Licensed Premises:_______________________________
STREET ADDRESS
____________________________________________________________
CITY/TOWN
8.
STATE
ZIP CODE
12-Digit License Number________-______-________-________
MUST BE FILLED IN CORRECTLY
9.
Contact Name________________________________________________
10.
Contact Telephone Number____________________________________
11.
Description of Applicant’s Job Duties:______________________
____________________________________________________________
___________________________________
SIGNATURE OF LICENSEE
__________________________
DATED
THIS AREA TO BE COMPLETED BY PARENT OR GUARDIAN OF
APPLICANT:
I, ____________________________________, parent/guardian of
_______________________________________, hereby consent to his/her
employment by the New Jersey Alcoholic Beverage Licensee named
herein.
___________________________________
SIGNATURE OF PARENT/GUARDIAN
__________________________
DATED
11/07
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