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10. MANAGER APPLICATION <br /> A. MANAGER INFORMATION <br /> The individual that has been appointed to manage and control the licensed business and premises. <br /> Proposed Manager Name Zohaib Shahid Date of Birth SSN <br /> Residential Address <br /> Email Phone <br /> Please indicate how many hours per week you intend to be on the licensed premises 50 <br /> B.CITIZENSHIP/BACKGROUND INFORMATION <br /> Are you a U.S.Citizen?* ()Yes QNo *Manager must be a U.S.Citizen <br /> If yes,attach one of the following as proof of citizenship US Passport,Voter's Certificate,Birth Certificate or Naturalization Papers. <br /> Have you ever been convicted of a state,federal,or military crime? ()Yes Q No <br /> If yes,fill out the table below and attach an affidavit providing the details of any and all convictions.Attach additional pages,if necessary, <br /> utilizing the format below. <br /> Date Municipality Charge Disposition <br /> C.EMPLOYMENT INFORMATION <br /> Please provide your employment history.Attach additional pages,if necessary,utilizing the format below. <br /> Start Date End Date Position Employer Supervisor Name <br /> 2010 2016 f Cashier Ye Olde Spirit Shoppe,SagamoreBeach <br /> 2010 2016 Cashier 7-Eleven,W.Yarmouth,MA Muatsim Chaudry <br /> 2016 20:18 Cashier Mashpee Mart;Mashpee,MA: Mohammad Sattar <br /> 2018 Present Half Owner/Cashier Mashpee Mart,Mashpee,MA N/A <br /> D.PRIOR DISCIPLINARY ACTION <br /> Have you held a beneficial or financial interest in,or been the manager of,a license to sell alcoholic beverages that was subject to <br /> disciplinary action? ()Yes QNo If yes,please fill out the table.Attach additional pages,if necessary,utilizing the format below. <br /> Date of Action Name of License State City Reason for suspension,revocation or cancellation <br /> I hereby swear under the pains and penalties,aïż½perjuWthat the information i have provided in this application is true and accurate: <br /> Manager's Signature Date DecemberZZ 2038 <br /> 5 <br />