HomeMy Public PortalAboutWPD Ice Cream Vendor ApplicationWatertown Police Department
552 Main St.
Watertown, MA 02472
Application
FOR NEW/RENEWAL OF A N ICE CREAM TRUCK OPERATOR'S LICENSE
Please check one:
New Applicant. Interested in Working for:
Company Name Address
Phone
Renewal — Most Recent Ice Cream ID License Number:
Employed with which Ice Cream Truck Company?
Company Name Address
Phone
Print or Type all Requested Information:
Last Name First Name Middle
Suffix
Residential Address City State
Zip Code
Home Telephone Cell Phone
Date of Birth Place of Birth
Mother's Maiden Name Father's Name
Height Weight Build Complexion
Hair Color Eye Color
Social Security Number MA Driver's License Number
Exp.Date
Present Employer Work Address
Work Telephone
Please Answer the Following Questions Completely and Accurately
1. Are you a citizen of the United States?
If not a U.S. Citizen, a Green Card Registration Must Be Presented.
If naturalized give date, place and naturalization number
Date Place
Naturalization
2. Have you ever been known by another name? If so, provide name and explain:
3. Other than Massachusetts, what other states have you resided in?
4. What is your age? You must be at least 18 years of age to apply for an Ice Cream Truck ID
5. Have you ever appeared in court as a defendant for any criminal offense
(excluding non -criminal traffic offenses)?
6. Have you ever been convicted of any crime?
7. Are you now or have you ever been defined as a Sex Offender under M.G.L. c 6 S 178C
8. Have you ever been convicted of Possession with Intent to Distribute or Trafficking of a controlled
substance as defined in MA General Laws C.94c S.1?
9. Have you ever violated any law regarding weapons or ammunition for which a term
of imprisonment may be imposed?
10. Are you or have you ever been treated or confined for drug addiction or habitual drunkenness?
11. Do you have any pending charge(s) for any offense(s) against the law?
12. Are you or have you ever been employed by another Ice Cream truck company?
If so, please provide name and city:
If you answered "YES" to any of the questions 5-11, Provide Details Which Must Include Dates,
Circumstances and Location (Attach Separate Sheet if Necessary)
References (Name, Address and Telephone Number):
1.
2.
3.
I declare the above facts are true and complete to the best of my knowledge and belief. I understand
that any false answer(s) will be just cause for denial or revocation of my license to operate an Ice
Cream Truckin the Town of Watertown.
Signature: Date: