Employee Permit Form PDF Details

Navigating the requirements for obtaining an employee permit in Indiana is essential for those seeking employment in sectors where such permits are required, particularly in the alcoholic beverage industry. The Indiana Alcohol & Tobacco Commission provides a structured application process through the Employee Permit Form, which caters to different types of permits, namely the 3-Year Employee Permit, the 2-Year Volunteer Employee Permit for those offering voluntary services to non-profit organizations, and the 2-Year Restricted Permit, each accompanied by distinct fees and conditions. These permits underscore the state's commitment to responsible alcohol service and the importance of legal compliance in the workplace. Applicants are required to provide comprehensive personal details, undergo a background check with questions focused on prior convictions, particularly related to operating a vehicle while intoxicated, and any history of permit denial, revocation, or suspension, which are critical factors in the application's evaluation. Additionally, awareness and completion of an approved server training course within a stipulated timeframe are mandatory, highlighting the emphasis on educated and responsible service of alcoholic beverages. Payment details, along with a declaration of truth and understanding of the legal implications of permit misuse, culminate the application process, signaling the final steps towards acquiring an employment permit in Indiana.

QuestionAnswer
Form NameEmployee Permit Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesindiana alcohol tobacco commission permit, employee liquor license, indiana applications for carriers alcoholic permit state form 47242, what is an employee permit

Form Preview Example

APPLICATION FOR EMPLOYEE PERMIT

3 Year Employee Permit - Type 900

2 Year Volunteer Employee Permit - Type 801

2 Year Restricted Permit - Type 300

State Form 43

Approved by State Board of Accounts, 2005

INDIANA ALCOHOL & TOBACCO COMMISSION

302 W. Washington Street, Rm. E114

Indianapolis, Indiana 46204

Employee Permit Section (317) 232-2455

Web page: http://www.IN.gov/atc

Hours: 8:00 am to 4:00 pm EST

 

 

 

 

 

STEP 1. GENERAL INFORMATION

 

 

 

 

 

 

 

 

Name of applicant (first, middle initial, last) (please print)

 

 

 

Daytime telephone number

 

 

E-mail address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (number and street)

 

 

 

City

 

 

 

State

 

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Number (Mandatory per IC 4-1-8-1 (a) (b))

Sex

 

 

 

Height (ft. in.)

Weight (lbs.)

 

Date of birth (month, day, year)

Age

 

 

 

 

 

Male

Female

 

 

 

 

 

 

 

 

 

 

Driver License Number

 

Permit number (if

renewal)

Check one that applies:

Employee Permit

 

19 -20 year old Restricted Permit

 

 

 

 

 

 

 

 

 

 

Volunteer Permit

 

 

 

 

 

 

Name and address of permit premises where this permit is to be used (if known).

 

 

 

 

 

 

 

 

 

If applying for a Volunteer Permit, list the name and address of the not for profit organization.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STEP 2. BACKGROUND QUESTIONS - READ CAREFULLY PRIOR TO ANSWERING

 

 

 

 

Yes

No

Are you aware that you must successfully complete an approved server training course within 120 days of employment?

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Have you been convicted of operating a motor vehicle while intoxicated in Indiana or of a similar charge in any other state within the last 10

years? (If yes, please list the month, day, year, and location of your conviction(s) ___________________________

 

 

 

 

 

 

 

 

 

Yes

No

Are you currently serving a sentence, including any term of probation for operating a motor vehicle while intoxicated in Indiana or a similar

crime in another state?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Do you have any outstanding and unpaid tax liabilities owing to the Indiana Department of Revenue? (If yes, you cannot have a permit until

 

 

all liabilities have been paid)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Have you had an application for an alcoholic beverage permit or employee's permit denied, revoked, or suspended within the last 5 years? If

yes, explain

_________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Have you ever had a drivers license in any other state in the last 10 years? If so, you must attach a copy of your driving record from that state.

 

 

 

 

 

 

 

 

Yes

No

Do you know that an excise officer may enter, inspect, and search the permit premises in which you work without a warrant and you must produce your

permit on demand?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Do you know that the alcoholic beverage laws are part of the criminal code and are enforceable by every law enforcement officer in the State of Indiana?

 

 

 

 

 

 

 

Yes

No

Do you understand that this employee permit is yours and that your employer is only allowed to copy the permit?

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Do you know that it is a Class B Misdemeanor, punishable by up to 6 months in jail and a $1,000 fine, for knowingly serving an intoxicated person?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STEP 3. 19-20 YEAR OLD RESTRICTED PERMIT

 

 

 

 

 

 

To receive a Restricted Employee Permit, you must attachthe original Certified Server Training Certificate issued to you at your training session. Photocopies

will not be accepted.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STEP 4. FEE AND PAYMENT SCHEDULE

 

 

 

 

 

 

Type 900 - 3 Year Employee Permit (Fee $45.00)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type 801 - Volunteer Employee Permit (voluntary services only for nonprofit organizations) (Fee $15.00)

 

 

 

 

 

 

Type 300 - 2 Year Restricted Permit (Fee $30.00)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You may work on your receipt pending issuance of your permit.

 

 

 

 

 

 

 

 

 

 

 

 

 

Payment by mail may be made by money order, business check, or certified check. DO NOT SEND CASH OR PERSONAL CHECKS.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STEP 5. SIGNATURE AND AFFIRMATION

 

 

 

 

 

 

I certify that this application was completed by myself. I affirm under penalties of perjury that I am at least 19 years of age and that all information provided on

this form is true and correct. I understand that it is a felony under Indiana law to misrepresent or falsify any portion of this application, and also realize I may be fined.

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of applicant

 

 

 

 

 

 

 

 

 

Date signed (month, day, year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWI Background Check

 

No OWI

OWI

 

OWI

 

No record on file

For Office Use Only

 

 

 

 

 

 

 

Eligible

 

Ineligible

 

 

 

 

Conviction Date(s)

 

 

Eligible Date

Revealed YES

NO

Initial & Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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