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Application For Certification (Responsible Vendor Program) RVP-1 - Alabama

Application For Certification (Responsible Vendor Program) Form. This is a Alabama form and can be used in Alcoholic Beverage Control Board Statewide .
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Application for Certification ALABAMA ALCOHOLIC BEVERAGE CONTROL BOARD RESPONSIBLE VENDOR PROGRAM FOR OFFICE USE ONLY CDR Date _________________ CDR Number: ______________ Reviewed By: ______________ Approved By: ______________ INSTRUCTIONS FOR COMPLETING THIS APPLICATION ·DO NOT submit this application until ALL employees of your establishment involved in alcoholic beverage sales are successfully trained and tested. ·Complete a separate application for EACH license for which you are requesting certification. ·Complete the Report of Server, Seller, or Manager Training and/or attach a separate training form ·Submit this application along with the thirty-five dollar ($35.00) surcharge per license to: The Alabama ABC Board, Responsible Vendor Program, P.O. Box 1151, Montgomery, Alabama 36101. PLEASE NOTE: THE SURCHARGE MUST BE IN THE FORM OF A CHECK OR MONEY ORDER. COMPLETE THIS INFORMATION AS IT APPEARS ON YOUR ALCOHOLIC BEVERAGE LICENSE! ABC LICENSE NUMBER: License Type -- License Number including County Code LICENSEE INFORMATION Licensee: ________________________________________________ Address: _________________________________________________ Street Address ________________________________________________________ City, State, and Zip Code Owner Telephone:__________________________________________ Email address:___________________________________________________ CUSTODIAN OF RESPONSIBLE VENDOR RECORDS: Name: __________________________________________________ Email address:___________________________________________________ Mailing Address: __________________________________________________ Street Address _______________________________________________________________ City, State, and Zip Code Please answer the following by marking the appropriate response: A) Has each server/seller and manager involved in the sale of alcoholic beverages, completed within this employment at this licensed establishment, an ABC Board approved course of instruction, appropriate to job function and passed an approved examination immediately prior to this application? B) Do you understand that persons employed in the future as a server/seller or manager must complete and pass an ABC Board approved course of instruction and examination within 30 days of such employment at this licensed establishment? C) Will you conduct on a semiannual basis, responsible vendor meetings for your servers/sellers and managers, or such other schedule of meetings as approved in writing by the Board, for review and update of instructions? YES NO TRADE LOCATION INFORMATION Trade Name: ________________________________________________ Address: ____________________________________________________ Street Address ___________________________________________________________ City, State, and Zip Code Trade Location Telephone:_______________________________________ Telephone : ________________________________________________ Physical Location of Records: ___________________________________ ___________________________________________________________ Street Address ___________________________________________________________ City, State, and Zip Code D) Have you developed a standard operating policy and procedure in writing, outlining discipline of employees who violate beverage laws or use/possess controlled substances on the licensed premises, and has each server/seller/manager acknowledged that he or she is aware of this policy? E) I agree to maintain the following information in the files of the licensee or designee: Employee's name, social security number, date of employment, course completion date, examination scores with signed corrections, trainer's name, and policy acknowledgments, and semiannual update documentation. F) Have you posted signs on your underage service policy, no less than 8 inches by 13 inches, and, are these signs displayed in unobstructed view inside the main customer entrance(s) and on or near the area where alcoholic beverages are displayed or dispensed? G) Are any ABC violations or actions pending against this license? YES NO Statement of Agreement and Understanding: Signature of Notary Public "I agree to comply at all times with, and to fully observe all the provisions of the Alabama Alcoholic Beverage Control Act, as it appears in the Code of Alabama, Title 28, the STATE OF _____________, COUNTY OF ____________________ Alabama Responsible Vendor Act of 1990, and all laws of the State of Alabama relative to the handling of alcoholic beverages. I further agree to obey all rules and regulations promulgated by the ABC Board relative to all alcoholic beverages received in this state. I Sworn to and subscribed before me this ________________ day of understand that certification shall be subject to withdrawal for cause at the discretion of the ________________________________, 20 _____. Board, and recertification will not be considered for 90 days. Signature and Title of Owner or Authorized Representative: __________________________________ Title ________________________ RVP-3-9-2012 American LegalNet, Inc. www.FormsWorkFlow.com Notary Signature: _______________________________________ My Commission expires__________________________________ NOTICE! Report of Server, Seller, or Manager Training form must be attached to this application.
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