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  1. City of Middleton Operator License Application
  2. Filling out your application:

    An operator license is a privilege, not a right.  Any false answers or omissions may result in the denial of your application.

    The City of Middleton will perform a background check to verify that the information you provided is complete and accurate.

    This application must be filled out completely and accurately.  All fees are non-refundable.

  3. License Type*

    Select the type of license you are applying for.

  4. *Renewals - Please only list the violations since your last application.
  5. Have you ever been convicted of a felony or misdemeanor (including criminal traffic offense)?*
  6. Have you been arrested for, received a summons to appear in court for, or paid a fine for any of the following?

     For multiple charges, attach additional pages.

  7. Any underage alcohol violation?*
  8. Operating a motor vehicle while intoxicated?*
  9. Selling or furnishing alcoholic beverages to underage person?*
  10. Permitting underage person on licensed premise?*
  11. Allowing person on licensed premises after closing?*
  12. Any alcohol related violation other than those listed above?*
  13. Sale or possession of drugs any kind?*
  14. Fighting, disorderly conduct, assault, or battery?*
  15. Resisting arrest or obstructing an officer?*
  16. List ALL and ANY convictions, citations, tickets, and pending charges not identified above.
  17. Within the last 2 years, did you have or complete one of the following?*
  18. I attest that the above information is true and correct and that any false or incomplete information may result in denial of my application.
  19. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
  20. Leave This Blank:

  21. This field is not part of the form submission.