HomeMy WebLinkAboutNew_Operator_ApplicationItems required with application:
❑ $60.00 Cash/Check Fee (fees are NON-REFUNDABLE)
❑ Copy of Driver's License/ID Oshkosh
❑ Copy of a Responsible Beverage Course Certificate
❑ Copy of Operator's License or Proof that you have completed the Responsible Beverage
Course in the past 2 years or currently hold a VAILD license in the state of Wisconsin
APPLICATION FOR OPERATOR'S LICENSE
Please be sure this application is complete and signed.
Last Name:
First Name: Middle Name/Initial:
Street Address:
City:
State: Zip: Phone Number:
Email:
Previous Name:
Date of Birth:
Please answer (circle) Yes or No to the 3 questions below:
1. Have you ever been convicted of ANY alcohol and /or ANY drug related offense in the last 10
years? NO YES If Yes, explain:
2. Have you EVER been convicted of a felony? NO YES If Yes, explain:
3. Are you currently under active supervision through probation and Parole? NO YES If Yes,
explain:
The undersigned certifies and declares that he/she is the applicant named in the foregoing application
and he/she has read each of the questions in the above application and that he/she has made
complete answers to each question, and that his/her said answers are true and correct.
Date: Signature of Applicant:
This applicant will be investigated by the Oshkosh Police Department. All approvals are
electronically recorded in the Evolve Data Base Record.
Please return this application with all applicable items in person, or by mail:
Oshkosh City Clerk's Office, Room 108
215 Church Avenue
Oshkosh WI 54903