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2. Complete the following columns for each person listed Employee Name 10-digit ID last four SSN digits-date of birth Hire Date and New Employee Orientation Date Completed the date the employee signs the form. EMPLOYEE NAME 10-DIGIT ID LAST 4 SSN-DOB HIRE DATE NEW EMPLOYEE ORIENTATION DATE COMPLETED OWNER/MANAGER SERVER/SELLER DATE TRAINED Establishment Name LID Owner/Manager Signature Date PLCB Representative Signature Date PLCB-2325 08/15 Reorder Item 4325 ALCOHOL SERVICE STAFF ROSTER INSTRUCTIONS serves alcohol or who checks IDs bartender security guard etc. including owners managers and club board members. 3. Update training dates as necessary. Please note Failure to accurately maintain the Alcohol Service Staff Roster may void your current RAMP certification.. This form MUST accompany your affidavit request to become RAMP-certified. The roster will be used to determine that at least 50 percent of your employees are currently trained in the PLCB-approved seller/server training program and that the owner or PLCB-approved manager attended owner/manager training. 1. List ALL current members of your alcohol service staff as defined above. Use additional forms as necessary. If you are granted RAMP certification a copy of the Alcohol Service Staff Roster will be mailed back to you for you to maintain for two years. DO NOT complete the shaded columns at this time. 3. Sign and date the bottom of the roster and enter the establishment name and license identification number LID. Responsible Alcohol Management Program Alcohol Service Staff Roster Please list all members of your staff including any owners and managers who serve alcohol or check identification. This roster should be updated and maintained and kept in the same manner in which you keep other business records. You are required to maintain accurate and truthful training records as detailed below 1. When employment is terminated remove the employee s name from the roster. 2. Add new employees who are considered part of your alcohol service staff to the roster and complete all columns. You are required to maintain accurate and truthful training records as detailed below 1. When employment is terminated remove the employee s name from the roster. 2. Add new employees who are considered part of your alcohol service staff to the roster and complete all columns.

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  • AFFIDAVIT
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