Laserfiche WebLink
AMEN DME IT-Chan re of Mangy ,er <br /> Chin .of License Mann ugr <br /> IA.mmmi A NAGER INFORMATION, <br /> The individual that has been appointed to manage and control the licensed business and premises. <br /> ........................................ <br /> Proposed Manager Name SCOTT MULLEN Date of Birth SSN <br /> ................. <br /> Residential Address <br /> Email SMULLEN@NEWSEABURY.COM <br /> Phone <br /> Please indicate how many hours per week <br /> 50 <br /> you intend to be on the licensed premises d Li Manager <br /> anager F1_11111111111111111117 � PEDRO T GONZALEZ <br /> ..........................- ........................................... --——----------- <br /> ........... <br /> .................................................. <br /> B. ITIZENSHIP/BACKGROUND INFORMATION <br /> ................. <br /> Are you a U.S.Citizen?* Yes No *Manager must be a U.S.Citizen <br /> If yes,attach one of the followin'g 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 re 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 /> C. EMPLOYMENT INFORMATION <br /> Please provide your employment history.Attach additional pages, if necessary, utilizing the format below. <br /> Start Date End D.................a..................t.................e........................................ Posimmmm <br /> tion Employer <br /> Supervisor Name <br /> ................................... <br /> 03/2'017 PRESENT FOOD&BEVERAGE MGR NEW SEABURY RESOURCES MGMT,INC CHRISTOPHER D.CARD <br /> ' 101/2016 '10/2016 GENERAL MANAGER VISCARIELLO HOSPITALITY GROUP SAMMY VISCARIELLO <br /> ........................... ........... <br /> 1999 112015 OWNER PRESCOTT BROKERAGE SERVICES MARYBETH PRESCOTT <br /> '11983 1999 GENERAL MANAGER BOSTON RESTAURANTS ASSOCIATION WILLIAM BARETTE <br /> .................................................................................. <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? C Yes No If yes,please fill out the table.Attach additional pages,if necessary,utilizing the format below. <br /> Date........o"f Action —Name'—of Lice..........................................................,n,s e State—City Reason for suspension,revocation or cancellation <br /> ............... <br /> ........... ............. <br /> I hereby�swe�at:undJ the pai�s and penalties of perjury that the information have provided in this application is true an accurate: <br /> 010 <br /> Manager'sate Signature c <br /> D 7 <br />