Application for Employment

Personal

First Name Genaro

Last Name Gilormino

Middle Initial J

Address ** ****** ***

Address * *** *

City Ansonia

State Connecticut

Zip 06401

EMail ac9d9e@r.postjobfree.com

Last 4 digits of SSN 9041

Phone 203-***-****

Available? Part Time Full Time

Are you willing to work overtime

as required?

Yes No

Are there any days when you

cannot work?

Yes No

What days are you unavailable? Mon Tue Wed Thr Fri Sat Sun Shift Preferred? 1st 2nd 3rd

Have you ever worked here

before?

Yes No

How did you learn of this

opening?

Employee Referral

Referrer Lisa Devellis Taylor

Availability

(Availability information is required)

Are you 18 years or older? Yes No

Are you applying for work in one

of the following states?

Yes No

Austin, Texas; Connecticut, District of Columbia, Hawaii, Illinois, Massachusetts, Minnesota, Oregon, New Jersey, Philadelphia, PA; Rhode Island, Montgomery Coun Baltimore, Prince George's County, Columbia, Maryland; Minnesota, Philadelphia, Pittsburgh, Pennsylvania; Buffalo, Rochester, New York City, Westchester County, Syracuse, NY; Los Angeles, Compton, Richmond, San Francisco, California State or Local Agency; Washington. Note: If you answer yes, as an employer we are prevented from obtaining certain data during the application process. Are you legally authorized to

work in

the United States?

Yes No

Will you now or in the future

require sponsorship for

employment visa status (e.g. H-

1B visa status)?

Yes No

Position

Position Applied For Warehouse

Wage or Salary desired?

When can you start? 04/16/2019

Eligibility

(Eligibility information is required)

16.00

Education

(Education information is required. Please list most recent institution first.) Type College

Institution Naugatuck Valley Community Tech College City Waterbury

State Connecticut

Zip 06820

Telephone Number 732-***-****

Last Name used while attending Gilormino

Attended From September 1998

Attended To June 2002

Graduated? Yes No

Major Liberal Arts and Sciences

Degree General studies

Work History

I have no prior work history.

May we contact your present

employer?

Yes No

Employer* City Line Food Distributors Inc

Employed From* December 2003

Currently work here? * Yes No

Employed To* December 2018

Address* 20 Industry Drive

City* West Haven

State* Connecticut

Zip* 06516

Telephone Number* 203-***-****

Job Title* Warehouse supervisor - maintenance dept Supervisor John Rubbo

Duties/Accomplishments*

Reason for leaving* Other

Reason I had gotten hurt on the job and had to leave Employer State of CT - Dmv

Employed From

At City Line, I was in charge of a four man crew and I was responsible for keeping aisles clean, mopping

$

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Company to make an investigation of any of the facts set forth in this application. I understand that employment at this Company is "at will," which means that either I or the Company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager or executive of the Company, has any authority to alter the foregoing. It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, gender identity or expression, religion, national origin, or other protected classification. I Accept

Name Genaro Gilormino

Genaro Gilormino

May 2003

Currently work here? Yes No

Employed To October 2003

Address 12 Dixwell Ave

City Hamden

State Connecticut

Zip 06825

Telephone Number 203-***-****

Job Title Camera operator

Supervisor Beth Krantz Gus Roman

Duties/Accomplishments Taking pictures in photo id dept Reason for leaving Laidoff

Employer Superior Storage

Employed From March 1997

Currently work here? Yes No

Employed To May 2002

Address 250 Executive Blvd

City Orange

State Connecticut

Zip 06514

Telephone Number 203-***-****

Job Title Recieving shipping clerk

Supervisor Nick Patch

Duties/Accomplishments Recieve the day's incoming product and put away Reason for leaving Laidoff

Driving Record

(Answer only if driving is a requirement of the job for which you are applying) Do you have a valid driver's

license?

Yes No

Drivers License Number 046917101

State Connecticut

Has any license, permit or

privilege ever been suspended or

revoked?

Yes No

Have you ever been denied a

license, permit or privilege to

operate a motor vehicle?

Yes No

Do you have any DUI or DWI

convictions?

Yes No

Have you had any traffic

convictions or forfeitures in the

past 3 years?

Yes No

Military Service

(Complete only if you served in the military)

Date: 04/12/2019 3:22p

By checking the acceptance box I am agreeing that this qualifies as my signature and that this communication is "in writing" as applicable to all laws, state and federal, regarding electronic communications and the content therein. Should I decide to revoke or withdraw my consent, I must notify the Human Resource Department at the company. I understand that I may contact the Human Resource Department to obtain a paper copy of this application. Click here to view our privacy policy.

Criminal History Check

NOTE: This portion of the application will only be reviewed by members of the Human Resource Department or the person (s) in charge of employment

First Name Genaro

Last Name Gilormino

Middle Initial J

Are you applying for work in one of the following states? Yes No Austin, Texas; Connecticut, District of Columbia, Hawaii, Illinois, Massachusetts, Minnesota, Oregon, New Jersey, Philadelphia, PA; Rhode Island, Montgomery Coun Baltimore, Prince George's County, Columbia, Maryland; Minnesota, Philadelphia, Pittsburgh, Pennsylvania; Buffalo, Rochester, New York City, Westchester County, Syracuse, NY; Los Angeles, Compton, Richmond, San Francisco, California State or Local Agency; Washington. Note: If you answer yes, as an employer we are prevented from obtaining certain data during the application process. I understand that the information provided above will not necessarily result in the rejection of my application, but that the nature of the information will be considered as it relates to the performance of the job duties in question and in light of the requirements of state and federal law. I Accept

Name Genaro Gilormino

Genaro Gilormino

Date: 04/12/2019 3:23p

By checking the acceptance box I am agreeing that this qualifies as my signature and that this communication is "in writing" as applicable to all laws, state and federal, regarding electronic communications and the content therein. Should I decide to revoke or withdraw my consent, I must notify the Human Resource Department at the company. I understand that I may contact the Human Resource Department to obtain a paper copy of this application. Click here to view our privacy policy.

(1) Applicants are not required to disclose any arrest, criminal charge or conviction, the records of which have been erased pursuant to section 46b-146 [of the Connecticut General Statutes, regarding juveniles], 54-76o [of the Connecticut General Statutes, regarding youthful offenders] or 54-142a [of the Connecticut General Statutes, regarding criminal records in general];

(2) that criminal records subject to erasure pursuant to sections 46b-146, 54-76o, or 54-142a are records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that has been dismissed or nolled, a criminal charge for which the person has been found not guilty or a conviction for which the person received an absolute pardon; and

(3) that any person whose criminal records have been erased pursuant to section 46b-146, 54-76o or 54-142a shall be deemed to have never been arrested within the meaning of the general statutes with respect to the proceedings so erased and may so swear under oath. Voluntary EEO Identification Form

NOTE: Completion of this form by applicant is strictly voluntary and will be filed separately from the application Various agencies of the United States Government require employers to maintain information on applicants pertaining to factors such as race, sex, and type of position for which an individual applies. The information requested on this sheet is for compliance with certain record keeping requirements. The Company believes all persons are entitled to equal employment opportunities and does not discriminate against its employees or applicants for employment because of race, color, sex, national origin, disability, veteran status, age, marital status, or any other protected group status. First Name Genaro

Last Name Gilormino

Middle Initial J

Position Applied For Warehouse

Gender Male Female

Race/Ethnic Data

White

Hispanic or Latino

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Two or more races

Elect not to self-identify

Regulations issued by the U.S. Department of Labor with respect to disabled individual, disabled veterans, and Vietnam Era veterans require that federal contractors provide an opportunity for self-identification to candidates seeking employment. Such self-identification is submitted on a voluntary basis, on a confidential basis, for use only in accordance with regulations, and without subjecting the individual to adverse treatment. Disabled Person

Vietnam Era Veteran(30% or more disability)

Newly Separated Veterans

Other Protected Veterans

Not a veteran

EXPLANATION OF THE CATEGORIES:

Hispanic or Latino: All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, North Africa or the Middle East. Black or African American (Not Hispanic or Latino): A persons having origins in any of the black racial groups of Africa. Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, Japan, Korea, Malaysia, the Philippine Islands, Thailand, Vietnam, India, and Pakistan. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands American Indian or Alaskan Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino): All person who identify with more than one of the above five races. Disabled Individual: means a disabled person who (1) has a physical or mental impairment which substantially limits one or more of such a person's major life activities, (2) has a history of such impairment, or (3) is regarded as having such impairment. Veteran of the Vietnam-era: means a person who: (i) served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or (ii) was discharged or released from active duty in the U.S. military, ground, naval or air service for a service-connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in any other location. Special Disabled Veteran: means (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service-connected disability. Newly Separated Veterans: means any veteran who served on active duty in the U.S. military, ground, naval or air service during the one-year period beginning on the date of such veteran=s discharge or release from active duty. Other Protected Veterans: means veterans who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.

AN EQUAL OPPORTUNITY EMPLOYER

I Accept

Name Genaro Gilormino

Genaro Gilormino

Date: 04/12/2019 3:24p

By checking the acceptance box I am agreeing that this qualifies as my signature and that this communication is "in writing" as applicable to all laws, state and federal, regarding electronic communications and the content therein. Should I decide to revoke or withdraw my consent, I must notify the Human Resource Department at the company. I understand that I may contact the Human Resource Department to obtain a paper copy of this application. Click here to view our privacy policy.

Background Release Form

In connection with your application and/or employment with above listed Company,"Really Good Stuff, LLC." hereinafter "the Company") this notice is provided to inform you that a

"consumer report" and/or "investigative consumer report," as defined by the Fair Credit Reporting Act (15 U.S.C. § 1681), may be obtained from a consumer reporting agency for employment purposes. These reports may include information about your character, general reputation, personal characteristics and mode of living, whichever are applicable. The report may also contain information about you relating to criminal history, credit history, motor vehicle records such as driving records, workers' compensation claims (post job offer or conditional job offer), verification of education or employment history, social media or other background checks. They may involve personal interviews with sources such as your neighbors, friends or associates. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report to the Company and National Crime Search, Inc., 3452 E. Joyce Blvd., Fayetteville, AR 72703 - 888-***-****. For information about National Crime Search, Inc.'s privacy practices see www.nationalcrimesearch.com. The scope of this notice and authorization is not limited to the present and, if you are hired, will continue and allow the Company to conduct future background screenings for retention, promotion or reassignment, unless revoked by you in writing. The Company also reserves the right to share your report with any third-party for whom you will be placed to work with as a representative of the Company. Acknowledgement and Authorization

You hereby authorize the obtaining of a consumer report and/or investigative consumer report at any time after receipt of this authorization by the Company, and if you are hired, throughout your employment, as permitted by law. You also confirm your understanding and provide consent for this report to be shared with a third-party for whom you may be placed to work as a representative of the Company, if applicable. First Name Genaro

Last Name Gilormino

Middle Initial J

Other Names Known by

Social Security Number ***-**-****

Date of Birth 4/14/1977

Drivers License Number

Required only if an essential

function of the job

046917101

State Connecticut

Address 15 Forest Ave

Apartment/Suite Apt 2

City Ansonia

State CT

Zip 06401

Contact Phone 203-***-****

Email ac9d9e@r.postjobfree.com

Prospective Employer Really Good Stuff, LLC.

Date 4/12/2019 3:28:31 PM

Client IP 172.58.229.39

I Accept

Name Genaro Gilormino

Genaro Gilormino

Date: 04/12/2019 3:25p

By checking the acceptance box I am agreeing that this qualifies as my signature and that this communication is "in writing" as applicable to all laws, state and federal, regarding electronic communications and the content therein. Should I decide to revoke or withdraw my consent, I must notify the Human Resource Department at the company. I understand that I may contact the Human Resource Department to obtain a paper copy of this application. Click here to view our privacy policy.

State Disclosures

Minnesota & Oklahoma applicants or employees only: Under state law you have a right to receive a copy of your consumer report, free of charge, if one is reques by Company. By checking "yes", a copy will be provided to you at the address you provide on this notice. New York applicants or employees only: Under state law you have the right to inspect and receive a copy of any investigative consumer report requested by Company by contacting National Crime Search, Inc. directly. You also acknowledge receipt of a copy of Article 23-A of the New York Correction Law by signing the Disclosure and Authorization.

Washington State applicants or employees only: Under state law you have a right to request a copy of the Washington Fair Credit Reporting Act's disclosures to consumers (RCW 19.182.070) by contacting National Crime Search, Inc. directly. Massachusetts/New Jersey: If you submit a request to National Crime Search, Inc. in writing, you have the right to know whether the Company ordered an investigative consumer report from National Crime Search, Inc. You may inspect and order a free copy of the report by contacting National Crime Search, Inc. directly California applicants or employees only: Under state law you have a right to receive a copy of your investigative consumer report and/or consumer credit report, fr of charge, if one is requested by Company. By checking "yes" a copy will be provided to you at the address you provide on this Notice. California applicants or employees only: You acknowledge receipt of a copy of the summary of the provisions of California Civil Code section 1786.22 by signing the Disclosure and Authorization form.

For California, Oklahoma, or Minnesota employees and applicants: Please check the appropriate box to indicate if you would like to receive a copy of your consumer report free of charge. Yes No

CALIFORNIA RESIDENTS

California Residents - this summary of the provisions of California Civil Code section 1786.22 is being provided to you pursuant to state law. Your employer intends to obtain information about you from an investigative consumer reporting agency, as defined under California law, for employment purposes. Under California law you are entitled to visually inspect all files maintained about you by an investigative consumer reporting agency (ICRA), such as National Crime Search, Inc., upon request and presentation of proper identification during normal business hours and on reasonable notice as follows: In person. You may request a copy of your file. The ICRA may charge you for the actual copying costs associated with providing you with a copy of your file. By telephone. A summary of all information contained in the ICRA's file about you will be provided to you via telephone, if you have made a written request for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you. By certified mail. You may make a written request for copies to be sent to a specified addressee. ICRA's complying with requests for certified mailings shall not b liable for disclosures to third parties caused by mishandling of mail after such mailings leave the ICRA.

"Proper Identification" includes documents such as a valid driver's license, social security account number, military identification card, and credit cards. If an ICRA is unable to reasonably identify you on the basis of these documents, they may require additional information concerning your employment and personal or family histor order to verify your identity.

The ICRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may require you to furnish a written statement granting permission to the ICRA to discuss your file in such person's presence. Background Release Form

First Name Genaro

Last Name Gilormino

Middle Initial J

A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en español, visite www.consumerfinance.gov/learnmore o escribe al Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information.

You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure". You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

a person has taken adverse action against you because of information in your credit report; you are the victim of identity theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance;

you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.

You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-***-****). The following FCRA right applies with respect to nationwide consumer reporting agencies: CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE You have a right to place a "security freeze" on your credit report, which will prohibit a consumer reporting agency from releasing information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans, and services from being approved in your name without your consent. However, you should be aware that using a security freeze to take control over who gets access to the personal and financial information in your credit report may delay, interfere with, or prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, or any other account involving the extension of credit. As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer's credit file. Upon seeing a fraud alert display on a consumer's credit file, a business is required to take steps to verify the consumer's identity before extending new credit. If you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years. A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line increases, and account upgrades and enhancements. You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.. States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact: TYPE OF BUSINESS: CONTACT:

1.a. Banks, savings associations, and credit

unions with total assets of over $10 billion and

their affiliates

b. Such affiliates that are not banks, savings

associations, or credit unions also should list, in addition to the CFPB:

a. Consumer Financial Protection Bureau

1700 G. Street N.W.

Washington, DC 20552

b. Federal Trade Commission:

Consumer Response Center

600 Pennsylvania Avenue, N.W.

Washington DC 20580

877-***-****

2. To the extent not included in item 1 above:

a. National banks, federal savings associations,

and federal branches and federal agencies of

foreign banks

b. State member banks, branches and agencies of

foreign banks (other than federal branches,

federal agencies, and Insured State Branches of

Foreign Banks), commercial lending companies

owned or controlled by foreign banks, and

organizations operating under section 25 or 25A

of the Federal Reserve Act

c. Nonmember Insured Banks, Insured State

Branches of Foreign Banks, and insured state

savings associations

d. Federal Credit Unions

a. Office of the Comptroller of the Currency

Customer Assistance Group

1301 McKinney Street, Suite 3450

Houston, TX 77010-9050

b. Federal Reserve Consumer Help Center

P.O. Box. 1200

Minneapolis, MN 55480

c. FDIC Consumer Response Center

1100 Walnut Street, Box #11

Kansas City, MO 64106

d. National Credit Union Administration Office of

Consumer Protection (OCP)

Division of Consumer Compliance and Outreach

(DCCO)

1775 Duke Street

Alexandria, VA 22314

3. Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings Aviation Consumer Protection

Division Department of Transportation

1200 New Jersey Avenue, S.E.

Washington, DC 20423

4. Creditors Subject to the Surface Transportation Board

Office of

Contact this candidate