APPLICATION FOR RESPONSIBLE VENDOR STATUS COMPLETE THE CORRESPONDING FORM IN ENGLISH If you wish to apply to the Responsible Vendor Program, please complete BOTH SIDES of the corresponding form IN ENGLISH. Mail your form to: Responsible Vendor Program, OLCC, P.O. Box 22297, Milwaukie, Oregon 97269-2297. Your application must be approved by OLCC, and you must have all criteria listed in questions 1-6 below in place prior to any violation for selling alcohol to a minor to be treated as a Responsible Vendor when OLCC applies sanctions. An applicant will not qualify for Responsible Vendor status if, within the last year, the licensee has personally committed or participated in a violation for selling alcohol to a minor that involved significant aggravating factors. PLEASE PRINT (IN ENGLISH) Trade Name: __________________________________ Licensee Name: _______________ ________________ Premises Address: ___________________________________________________________________________ Phone Number: _________________________________ I attest that all of the information I have provided in this application is true: ________________________________________ ___________________________________ Print Name in English Licensee Signature/Corporate Officer ____________ Date Notice: This section must be signed by a licensee or an authorized corporate officer. ORS 471.315(1)(B) provides that OLCC may cancel or suspend your license or impose a civil penalty if it finds a licensee has made any false representation or statement to the Commission in order to induce or prevent action by the Commission. RESPONSIBLE VENDOR PROGRAM CRITERIA ALL QUESTIONS MUST BE ANSWERED TRUE FALSE 1. _____ _____ My employees have read and signed my house policies that, at a minimum, include the following: (1) valid forms of acceptable ID, (2) how to properly check ID, including for anyone who looks under 26, (3) consequences for selling alcohol to a minor. My policies are posted in an area visible to all my employees. 2. _____ _____ I have permanently posted the following signs where customers and employees can see them: (1) valid forms of acceptable ID in Oregon, (2) anyone who appears under age 26 must show identification. 3. _____ _____ My employees accept only valid, stand-alone identification legally allowed by statute. 4. _____ _____ At a minimum, I hold 4 annual employee trainings covering: (1) acceptable forms of ID, (2) how to check ID, (3) checking ID of anyone who appears under 26, (4) a review of house policies. I keep attendance records and minutes for each meeting. 5. _____ _____ In the past 5 years, I have NOT personally committed any of the following category I or II violations: felony conviction; use of service permit by another; operating other than my license permits (selling alcohol not allowed under license, violating license restrictions); failure to notify prior to change of ownership; ceased dispenser operation; operating while suspended; made false statement to OLCC; interfered with an investigation; visibly intoxicated while on duty; failed to call police at inspector's request; failed to promptly admit inspector or police officer; habit of abusing alcohol or controlled substances. 6. _____ _____ Before selling alcohol, each of my employees reads and signs the OLCC brochure What Every Store Clerk Needs to Know about Selling Alcohol, or meets the alternative requirements of OAR 845-009-0130, and my records are in compliance with this same rule. In addition, within three days of beginning to sell alcohol, each of my employees receives training on: (a) how to recognize minors and visibly intoxicated persons; (b) legal forms of identification; (c) how to properly check ID and how to recognize false or altered ID; (d) the requirement that anyone who appears under 26 must show valid ID; (e) recommended approaches for refusing sales to minors or visibly intoxicated persons; and (f) a review of the consequences for selling alcohol to minors and the importance of not selling alcohol to minors or visibly intoxicated persons. New employees with a valid service permit are exempt from the three-day training requirement. OLCC use only: ____Approved ____Returned ____Rejected By:__________________________ (rev. 03/07) American LegalNet, Inc. www.FormsWorkflow.com MY HOUSE POLICY ON ALCOHOL SALES & CHECKING IDENTIFICATION Use the corresponding form to complete your answers in English. Licensee Name ________________________________________________________ Trade Name ________________________________________________________ Business Location ________________________________________________________ Phone Number ________________________________________________________ 1. The only types of identification my employees are allowed to accept are: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 2. If my employee sells alcohol to a minor, I understand there will be legal consequences. If my employee sells to a minor, my policy is: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 3. I require my employees to check the identification of anyone who appears under the age of ______________. 4. To properly check identification, I require my employees to do the following: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________ Your Name and Position (Print in English) _____________ Date 9079 SE McLoughlin Blvd. Portland, OR 97222-7355 Ph (503) 872-5000 Fax (503) 872-5018 Toll free (800) 452-6522 www.olcc.state.or.us Promoting Responsible Alcohol Sales and Service American LegalNet, Inc. www.FormsWorkflow.com