Form CGCC-CH2-03 "Notification of Employee Separation" - California

What Is Form CGCC-CH2-03?

This is a legal form that was released by the California Gambling Control Commission - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2020;
  • The latest edition provided by the California Gambling Control Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CGCC-CH2-03 by clicking the link below or browse more documents and templates provided by the California Gambling Control Commission.

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Download Form CGCC-CH2-03 "Notification of Employee Separation" - California

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State of California
California Gambling Control Commission
Notification of Employee Separation
CGCC-CH2-03 (New 05/20)
Page 1 of 2
MAIL COMPLETED FORM TO:
BUREAU OF GAMBLING CONTROL
P.O. Box 168024
Sacramento, CA 95816-8024
(916) 830-1700
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE YOU COMPLETE THIS FORM
All information must be typed or printed legibly in blue or black ink. If the space available is insufficient, attach a separate sheet of
paper and precede each answer with the applicable section and question number. Any corrections, changes, or other alterations must
be initialed and dated by the applicant.
SECTION 1: OWNER CATEGORY LICENSEE INFORMATION
TYPE OF LICENSE
C
TPPPS B
L
ARDROOM BUSINESS LICENSE
USINESS
ICENSE
NAME OF BUSINESS
SECTION 2: EMPLOYEE CATEGORY LICENSEE INFORMATION
Provide the following information about the employee category licensee who has separated employment.
FULL NAME: LAST
FIRST
MIDDLE
LICENSE NUMBER
A) E
C
L
MPLOYEE
ATEGORY
ICENSE
Provide one of the following:
Key Employee License
Commission Work Permit
TPPPS Supervisor License
TPPPS Worker License
PLEASE PROVIDE THE REASON(S) FOR SEPARATION:
State of California
California Gambling Control Commission
Notification of Employee Separation
CGCC-CH2-03 (New 05/20)
Page 1 of 2
MAIL COMPLETED FORM TO:
BUREAU OF GAMBLING CONTROL
P.O. Box 168024
Sacramento, CA 95816-8024
(916) 830-1700
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE YOU COMPLETE THIS FORM
All information must be typed or printed legibly in blue or black ink. If the space available is insufficient, attach a separate sheet of
paper and precede each answer with the applicable section and question number. Any corrections, changes, or other alterations must
be initialed and dated by the applicant.
SECTION 1: OWNER CATEGORY LICENSEE INFORMATION
TYPE OF LICENSE
C
TPPPS B
L
ARDROOM BUSINESS LICENSE
USINESS
ICENSE
NAME OF BUSINESS
SECTION 2: EMPLOYEE CATEGORY LICENSEE INFORMATION
Provide the following information about the employee category licensee who has separated employment.
FULL NAME: LAST
FIRST
MIDDLE
LICENSE NUMBER
A) E
C
L
MPLOYEE
ATEGORY
ICENSE
Provide one of the following:
Key Employee License
Commission Work Permit
TPPPS Supervisor License
TPPPS Worker License
PLEASE PROVIDE THE REASON(S) FOR SEPARATION:
Notification of Employee Separation
Page 2 of 2
SECTION 3: DECLARATION
I declare under penalty of perjury under the laws of the State of California that the information in this form is true, accurate, and complete, and that
this declaration is executed by me at
.
City and State
PRINTED NAME
SIGNATURE
CAPACITY
DATE (MM/DD/YYYY)
This form must be signed by the appropriate person identified below:
 If licensee is a corporation, LLC, or joint venture then by an authorized officer.
 If licensee is a general partnership or limited partnership then by an authorized partner.
 If licensee is a sole proprietor then by the owner.
 If licensee is a trust then by an authorized trustor or trustee.
 If licensee is a natural person then by the licensee.
Page of 2