ABLE CONTROL NUMBER NEW LICENSE NUMBER (Check one) NEW APPLICATION_______ RENEWAL APPLICATION________ LICENSE NUMBER________________ (Check One License Type; A separate application is required for each license type) EXPIRATION DATE________________ _________Charity Games Employee ($15.00) _____ Charity Games Manager ($50.00) _________Alcohol Bev. Employee ($30.00) _________Alcohol Bev. Agent ($55.00) _______Manufacturing Agent ($55.00) PLEASE TYPE OR PRINT NAME_________________________________________________________________________________________________ First Name Middle Name Last Name Other name (if any) ______________________________________________________________________________________ Home or Mailing Address_________________________________________________________________________________ NOT EMPLOYER ADDRESS City__________________________________________________ State_______________ Zip Code ___________ Sex M F Social Security Number _____________________ (Check one) Phone Number (Home)_________________________________ (Work)_________________________________________ Driver License Number___________________________________________ ________________________________ Number State Employer (if any) _____________________________________________________________________________________________________ ______________________________________________________________________________________________________ Street Address City State Zip ANSWER EACH OF THE FOLLOWING QUESTIONS. EACH YES ANSWER REQUIRES AN EXPLANTION. 1. Have you ever been convicted of or pled guilty or nolo contendere to any Felony? YES_______________NO_____________ If YES, for what, where (city, county and state), and when convicted. ___________________________________________________________________________________________________________ 2. Have you ever been convicted of or pled guilty or nolo contendere to a misdemeanor related to gambling or gaming? If YES, for what, where (city, county and state), and when convicted YES_______________NO_____________ ___________________________________________________________________________________________________________ 3. Are you Employed as: a) a judge, district attorney, or public official who sits in a judicial capacity with YES_______________NO_____________ jurisdiction over the Oklahoma Alcoholic Beverage Control Act? b) a peace officer engaging in law enforcement activities? YES_______________NO_____________ c) a Tax Commission employee engaging in auditing, enforcing, or collecting of alcoholic beverages taxes? YES_______________NO_____________ If you answered YES to any of the above, where do you work and what do you do? ________________________________________________________________________________________________________ 4. Are you a United States Citizen? YES_________________NO_______________ If you answered NO to the above question, please provide a copy of a permanent residence card Applicant Signature:__________________________________________________________ This is a WEB Mail-In Employee Application. All payments of fees should be made payable to the Oklahoma ABLE Commission 3812 N. Santa Fe, Ste 200 OKC, OK 73118. The License fee may be paid by cashier's check, money order or personal check. PLEASE DO NOT SEND CASH. Be certain that the application is legible. Applications that are illegible, incomplete, not accompanied by the required fee, or found to be inaccurate will be denied. Once your eligibility to hold a license has been verified your license will be mailed to your home address. For those applying by certified mail the certified mail receipt and proper identification will serve as a temporary license for a period not to exceed thirty (30) days. American LegalNet, Inc. ABLE Form Lic-017 Revised 10/2011 DO NOT SUBMIT EARLIER VERSIONS OF THIS FORM www.FormsWorkFlow.com Date of Birth___________________ Age________