Manager's Certificate (New or Renewal): Application Details

*- indicates required field.

To The Secretary, Waipa District Licensing Committee. Application for a managers certificate is made in accordance with the details set out below:

The following information & documentation is required to be submitted with this application. Please upload the documents to the 'Attachments' tab. Incomplete applications will not be processed.

Details of Applicant

New Application

- Licence Controller Qualification

- 1 written reference from the applicants employer at the licensed premises of which they are currently working which confirms experience

- Identification (driver's licence or valid passport)

- Valid Work Visa (if applicable)

- CV/Resume and other evidence regarding character, suitability and training to support the application
Renewal Application

- Licence Controller Qualification Certificate if relevant

- Valid Work Visa (if applicable)

- Copy of current managers certificate if not issued by Waipa DC

Please note: If your certificate will expire in the next 3 days we advise that you pay the renewal fee immediately to avoid having to apply for a new Certificate. You can do this via internet banking. Online payments can be made here.

Type of application: *

New Managers Certificate

Renewal of Managers Certificate

Full name: *

Your residential address *

Can't find your address? CLICK HERE to Enter it manually

Is your postal address and residential address the same? *

Yes

Preferred Contact? *

Landline

Mobile

Landline (optional)

Mobile: (optional)

Email: *

If your application is approved the certificate documents will be emailed to this address

Date of birth: *

Place of birth: *

Gender: *

Male

Female

Current occupation/duties at this licensed premises: *

Current place of employment (where your managers certificate will be utilised): *

Address of place of employment *

Can't find your address? CLICK HERE to Enter it manually

How long has the applicant been employed at this licensed premises? (optional)

How many hours per week (on average) does the applicant work at this licensed premises? *

Has the applicant been convicted of any offences (including any alcohol or traffic but not parking)? *

Yes

Note: State all criminal convictions and pending matters including drink driving infringement notices (other than convictions for offences against provisions of the Land Transport Act 1998 not contained in Part 6, and offences to which the criminal records (clean slate) Act 2004 applies)

Are you currently awaiting the hearing of charges in a civil or criminal court of law? *

Yes

Have you ever appeared or are due to appear before a District Licensing Committee or Alcohol Regulatory Licensing Authority (ARLA) for any reason or have you ever had a managers certificate refused, suspended or cancelled at any stage or been party to a license that was refused, varied or cancelled at any stage? *

Yes

Manager's Certificate (New or Renewal)

Application Details

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Application Details

Details of Applicant