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Application To Determine Qualifications Of Manager ABC-405M - California

Application To Determine Qualifications Of Manager Form. This is a California form and can be used in Department Of Alcoholic Beverage Control Statewide .
 Fillable pdf Last Modified 3/4/2014
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Department of Alcoholic Beverage Control APPLICATION TO DETERMINE QUALIFICATIONS OF MANAGER State of California Edmund G. Brown Jr., Governor LICENSE NUMBER RECEIPT NUMBER FEE $ PART I: To be completed by manager I hereby request the Department of Alcoholic Beverage Control to determine my qualifications as manager of the on-sale licensed premises designated below, as provided by Rule 57.6 of the Department's Regulations and pursuant to Business and Professions Code Section 23788.5. ($100.00 fee) APPLICANT NAME LICENSEE NAME PREMISES ADDRESS 1. Date assumed managerial duties at licensed premises? 2. Have you been previously qualified as a manager by the Department? Yes _______ No ________________ list name and address of business(es) you managed: If Yes, Dates of employment as manager at that location(s): 3. Do you have a written managerial agreement/contract? Yes _________ No _________ (If Yes, Attach Copy) 4. Salary? _________________ (Yearly / Monthly / Bi-weekly / Weekly / Percentage). 5. Commission or bonus? Yes ________ No ________ 6. Managerial duties: Hire & fire employees? Order new merchandise? Participate in policy decisions? Authority to write checks? Other applicable duties? 7. Are you replacing an already qualified manager at this premises? Yes ______ No _______ If Yes, prior manager's name: I declare under penalty of perjury that I am the applicant named in the foregoing application, that I have read the foregoing application and know the contents thereof, and that each and every statement made and answer given therein is true and correc t. APPLICANT NAME APPLICANT SIGNATURE DATE SIGNED If Yes, gross or net? Yes Yes Yes Yes Yes ______ ______ ______ ______ ______ No _______ No _______ No _______ No _______ No _______ PART II: To be completed by on-sale licensee The facts concerning the employment as manager of the above-listed applicant are true as indicated. I further agree that I will promptly provide a copy of any written agreement or letter that may exist pertaining to the manager's duties, responsibilities and/or amount and manner of compensation and further will notify the Department upon the termination of applicant's employment as manager or transfer to another premises. DATE OF EMPLOYMENT OR EXPECTED EMPLOYMENT LICENSEE MAILING ADDRESS (Street number and name, city, state, zip code) LICENSEE SIGNATURE ABC-405M (rev. 02/14) American LegalNet, Inc. www.FormsWorkFlow.com
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