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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 Ghulam Rasool Date of Birth I SSN <br /> Residential Address <br /> Email Phone , <br /> Please indicate how many hours per week you intend to be on the licensed premises 40+ <br /> B.CITIZENSHIP/BACKGROUND INFORMATION <br /> Are you a U.S.Citizen?' Yes :No *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 d No <br /> w <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 /> - _ <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 /> aY. ...-.....— .. <br /> C -e <br /> esu e--atfia h d <br /> 5 e rr� <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 ■,No If yes,please fill out the table.Attach additional pages,'if necessary,utilizing the format below. <br /> w <br /> Date of Action Name of License State City Reason for suspension,revocation or cancellation <br /> !hereby swear under the painsd penalties o perjury hat the informatio r provided in this application is true and accurate: <br /> Manager's Signature Date <br /> 5 <br />