Local Liquor Licensing Authority Application

To apply for a position on the Liquor Licensing Authority please complete this application. Your responses will be sent electronically to the City Clerk's office (Northglenn City Hall, 11701 Community Center Drive, Northglenn, CO 80233). You will be contacted when a position becomes available. If you have any questions, please contact the City Clerk at 303.450.8755.

* First Name:
Middle Name:
*Last Name:
*Street Address:
*City, State, Zip:
*Home Phone Number:
Work Phone Number:
*Length of Residency (years + months):
*Date of Birth:
Email Address:
*Occupation:
*Employer:

Please list your specialized business skills or education:

Please list any civic activities in which you have been involved:

Have you ever attended any of the City's Boards or Commissions or City Council meetings? How about any similar meetings in other communities? Please list:

Are you familiar with the master plan and/or ordinances of the City of Northglenn? What about similar plans or ordinances in other communities? Please list:

What traits or characteristics do you feel you can offer in problem resolution? Please list:

Why are you interested in serving on the Liquor Licensing Authority?

Do you have any personal or religious objections to the use of alcoholic beverages? Please explain:

* Do you have an abhorrence of alcohol?

Y N

* Do you have, or have you ever had, a financial interest (direct or indirect) in a beer or liquor licensed establishment?

Y N

If yes, please give the name of the establishment(s) and your relationship, e.g., owner, stockholder, etc:

If yes, are you currently involved with this establishment?

Y N

Have you ever committed any alcohol-related offense? If so, please explain:

Are you related to any employee, appointee or elected official of the City of Northglenn? If so, please list them here:

If you receive favorable consideration for an appointment to a Board or Commission, would your schedule allow you to attend these meetings? If not, identify the number of meetings you would likely miss each year:

Do you currently serve on any other Boards or Commissions? If yes, please list them here:

PLEASE NOTE: Relatives of elected and appointed City officials are NOT ELIGIBLE for regular full-time and permanent employment with the City. In the event that an employee's relative is elected to Council or appointed to a Board or Commission of the City by Council, the employee will cease to be eligible for City employment during the term of office of the relative. After the term of office for the relative has ended, the employee may re-apply for City employment as vacancies occur.

Relatives include spouse, children, parents, grandparents and siblings, as well as members of step-families, foster families and adoptive families and in-laws. This regulation also applies to other relatives living in the same household.

Please read the following carefully. By submitting this application, you: