Fillable Form Abc-805 - Employee Registration - Kansas Department Of Revenue printable pdf download

Form Abc-805 - Employee Registration - Kansas Department Of Revenue

Download a blank fillable Form Abc-805 - Employee Registration - Kansas Department Of Revenue in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Abc-805 - Employee Registration - Kansas Department Of Revenue with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

KANSAS DEPARTMENT OF REVENUE

ALCOHOLIC BEVERAGE CONTROL DIVISION

915 SW Harrison Street, Room 214

Topeka, Kansas 66625-3512

Telephone 785-296-7015 Fax 785-296-7185

EMPLOYEE REGISTRATION

SECTION 1 – LICENSEE INFORMATION

New Application

Renew Application

Add New Employees Only

Licensee DBA Name

License Number

Telephone Number

__ __ - __ __ __ - ___ ___ ___ ___ - ___ ___

Location Address

City

Zip Code

E-mail Address

SECTION 2 – EMPLOYEE/VOLUNTEER REGISTRATION INFORMATION

Additional pages attached:

Yes

Page

_____ of _____

GENDER

DATE OF

FULL NAME OF EMPLOYEE/VOLUNTEER

DATE OF

DRIVERS LICENSE #

STATE

POSITION

SSN #

HIRE

(CIRCLE

BIRTH

OR ID #

OF ISSUE

(CIRCLE ONE)

LAST

FIRST

ONE)

(MM/DD/YY)

B W C M

I certify that the person(s) whose name appears on this form and any attachments is qualified to be employed in a licensed establishment. I further certify that when a new person is employed, the ABC

Director will be notified within five days.

__________________________________________________________________________________________________________________________________________________________________

SIGNATURE OF LICENSEE OR MANAGER

TITLE

DATE

1 – New License or Renewal Applications: List all employees for your license type that work in the positions listed below. Submit a complete list of employees only when applying for a new license or renewing your license.

2 – Add New Employees: List new employees only within five (5) days after they begin work. Do not submit previously registered employees.

3 – Date of Hire – Enter the date of hire for new employees only.

On-Premise Licensees – Only list employees/volunteers who mix, serve, sell or dispense alcoholic liquor and their managers. Positions: B=Bartender; W=Waitress/Waiter and M=Manager.

Clear Form

Off-Premise Licensees – List all employees for new license or license renewal. Positions: C=Clerk or M=Manager

ABC-805 (7.1.09)