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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 /> Date of Birth SSN <br /> Proposed Manager Name Zohaib Shahid Da � <br /> Residential Address <br /> Email Phone <br /> Please indicate how many hours per week you intend to be on the licensed premises 50 <br /> FAreIZENSHIP/BACKGROUND INFORMATION <br /> ou a U.S.Citizen?* QYes ()No *Manager must be a U.S.Citizen <br /> ,attach one of the following as proof of citizenship US Passport,Voter's Certificate,Birth Certificate or Naturalization Papers. <br /> ave 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 /> Charge <br /> Disposition <br /> Date Municipality g <br /> C.EMPLOYMENT INFORMATION <br /> Please provide your employment history.Attach additional pages,if necessary,utilizing the format below. Supervisor Name <br /> Start Date End Date Position Employer p <br /> 2010 2016, Cashier Ye Olde Spirit Shoppe,SagamoreBeach <br /> 2010 2016 Cashier <br /> 7-Eleven,W.Yarmouth,MA Muatsim Chaudry <br /> 2016 2018'; Cashier <br /> Mashpee Mart,Mashpee,MA Mohammad Sattar <br /> Mashpee Mart,Mashpee,MA N/A <br /> 2018 Present Half Owner/Cashier P <br /> D.PRIOR DISCIPLINARY ACTION <br /> ect to <br /> Have you held a beneficial or financial interest please fll out the table.Attacheen the manager of,a license to sell addit oral pages f nlecessary,gtiliz ng the format below. <br /> disciplinary action? QYes QNo Ifyes,p <br /> Date of Action Name of License State City Reason for suspension,revocation or can <br /> 1 hereby swear under the pains and penalties of perjury that the information i have provided in this application is true and accurate: <br /> Date February r ,2019 <br /> Manager's Signature <br /> 5 <br />