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2. All new employees that are required to hold a Palatine Alcoholic Beverage Seller and Server Permit must register with the Police Department within 72 hours upon becoming employed by the establishment.
4. Establishment Information
6. Establishment Name*
8. Employee Information
10. First Name*
11. Last Name*
13. Street Address*
15. City*
16. State
    -- Select One --AlabamaAlaskaArizonaArkansasArmed Forces - AAArmed Forces - AEArmed Forces - APCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
17. Zip Code*
19. Phone*
20. Email
22. Date of Birth*
    Date of Birth
23. Date of Hire*
    Date of Hire
24. Job Title*
26. New managers or employees who are required to hold a Palatine Alcoholic Beverage Seller and Server Permit must secure a permit from the Village within 30 days from the beginning of their employment. Until a permit is issued by the Village, the new manager or employee shall work under the supervision of a person who has received a Palatine Alcoholic Beverage Seller and Server Permit.
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28. 1. Receive an email copy of this form.
29. Email address

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30. Submit

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