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........... ............... ------------- ............................ .......... <br /> 10. MANAGER A P PLICAT111.10N . <br /> MANAGER INFORMATION <br /> The individual that has been appointed to manage and control the licensed business and premises. <br /> ............ <br /> Proposed Manager Name[ Michael Wilkinson Date of Birth <br /> ,SN <br /> Residential Address <br /> -——--------------------- ............................................................................... ....................................... <br /> .... ...Email Phone <br /> .......................................................... <br /> Please indicate how many hours per week you intend to be on the licensed premises �72( <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.? C Yes 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 /> .......... ............ <br /> Date Municipality Charge Disposition <br /> ........... .................... ...... <br /> ................................. <br /> ........................ ...................... <br /> ..........--, <br /> ..................... ........ .....................--1........... <br /> ................ .............................................................. ................. ........................ .............................. <br /> ............... -—----- <br /> ww <br /> ---LJ <br /> ................... ............ �mm.................................... ........................... .................... <br /> C.EMPLOYMENT INFORMATION <br /> .. ......................... ---........ <br /> Please provide your employment history.Attach additional pages,if necessary,utilizing the format below. <br /> e J, <br /> Start Date Position <br /> Employer Supervisor Na................ <br /> .............. ..................... .......................... me <br /> wwww <br /> 7/31/18 Owner The Little Shop of Olive Oils Owner <br /> ................ ............. <br /> ................ ...........111-1-11-1-� <br /> ...... ... ........................................... .Ian. ........... <br /> ............ ................................ <br /> ...................... ....................... <br /> Nmnmmmmmmmmmm m rm uuumrrrrrra <br /> ....................... .............................. <br /> ...................... <br /> D.PRIOR DISCIPLINARY ACTION <br /> ..................... ............................................ <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 Co No If yes,please fill out the table.Attach additional pages,if necessary,utilizing the format below. <br /> mmm ....... ..... <br /> -b-a-f of Action Name of License State City Reason for"suspension,revocation or cancellation........... ............... <br /> ................. <br /> ................. .................................................„rt.......................... ............. <br /> .................. (�..................... ............ ....... <br /> ...................... <br /> ............. <br /> hereby swear under the pains and penalties of perjury that the information I have provided in this application is true and accurate: <br /> ........... <br /> Manager's Signature ' <br /> Date <br /> ...........-........... ......................................... <br /> 5 <br />