***** - ******, **********-*****
Personal Information
Please complete and review the information below and click the forward arrow at the bottom to continue. Personal Information
Legal First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Robert Legal Middle Name (If no middle name, leave blank) .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L Legal Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gilford Address Line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Paterson Ave Address Line 2 (optional) .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Egg Harbor Township Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States State/Province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Jersey Zip/Postal Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08234 Primary Telephone Phone (nnn-nnn-nnnn) .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609-***-**** General Information
Have you ever worked at or supported IEH Auto Plus LLC or The Pep Boys - Manny, Moe & Jack, or any of their subsidiaries as a permanent employee, temporary employee, contractor, or intern?
No
Please explain further by indicating your employment status (permanent, temporary, contractor, or intern), dates of employment, and manager/supervisor name(s).
I was furlough from Marjam on 04-05-2020. Supervisor Mike 609-***-****. Unemployed Are you at least 18 years of age? Yes
Do you currently have the legal right to work in the United States? Yes Have you signed any non-compete or non-solicit agreements with any other employer that might restrict you from working for IEH Auto Plus LLC, The Pep Boys- Manny, Moe & Jack, or any of it's subsidiaries? You also may be required to furnish a copy of the agreement.
No
If yes, please explain:
Are you a relative of any Company employee? No
If yes, provide name, relationship, and location of employee. Are you able to perform, with or without reasonable accommodation, the essential functions of the job for which you are applying? Yes The Company will work with an otherwise qualified individual to reasonably accommodate his or her disability. Job applicants should direct all requests for accommodations to Human Resources in New York.
In the future will you require sponsorship for employment visa status (e.g. H-1B visa status)? No
If yes, state work permit or visa type and expiration date. Immigration Reform and Control Act (IRCA)
The Immigration Reform and Control Act (IRCA) prohibits the employment of unauthorized aliens and further requires that if you are hired, the Company must verify your identity and your authority to work in the United States, even if you are a U.S. citizen. You are responsible for obtaining and providing the documentation required to perform the verification. (Information concerning this verification procedure and requirements is available upon request.) Icahn Automotive Group LLC (the "Company"), will make all employment decisions regarding employees and applicants for employment without discrimination or harassment based on race, color, religion, gender, national origin, sexual orientation, age, disability, pregnancy, marital status, veteran status, alienage or citizenship status, creed, genetic predisposition or carrier status, status as a victim of domestic violence, or any other category protected by federal, state, or local law. Click the forward arrow at the bottom to continue. Employment History
Note: Account for a minimum of 5 years' employment history (most recent first including periods of self-employment). To add additional employers, click the Add Employer button below to add additional employers.
*= System Required
*= Conditionally Required based off previous answer Previous Employer 1
Employment Type .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Previous If you do not have any prior experience, select "No Previous Experience" from the dropdown. No other fields will be required. Name of Employer * Marjam
Job Title * Laborer
Employer Phone *
nnn-nnn-nnnn
City * Pleasantville
Country * United States
State* New Jersey
Supervisor's Name * Mike
Start Date (please select the first day of the month if you do not recall the exact date)* 10/12/2019
End Date (please select the first day of the month if you do not recall the exact date) 04/05/2020
Describe work performed and scope of responsibilities. * Load/unload work trucks with forklift,load customers. Clean trucks,yard & warehouse and deliveries. May we contact this employer? Yes
Previous Employer 2
Employment Type .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you do not have any prior experience, select "No Previous Experience" from the dropdown. No other fields will be required. Previous
Name of Employer * Manpower
Job Title * Laborer
Employer Phone *
nnn-nnn-nnnn
City * Vineland
Country * United States
State* New Jersey
Supervisor's Name * Vivkie
Start Date (please select the first day of the month if you do not recall the exact date)* 01/12/2015
End Date (please select the first day of the month if you do not recall the exact date) 12/26/2019
Describe work performed and scope of responsibilities. * Construction to packing gifts to putting in Paul's truck driver bobcat excavator jackhammers to distribute liquor in the casinos etc...
May we contact this employer? Yes
Previous Employer 3
Employment Type .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you do not have any prior experience, select "No Previous Experience" from the dropdown. No other fields will be required. Previous
Name of Employer * Crystal Springs water
Job Title * Laborer/truck driver
Employer Phone *
nnn-nnn-nnnn
City * Pleasantville
Country * United States
State* New Jersey
Supervisor's Name * Mark
Start Date (please select the first day of the month if you do not recall the exact date)* 09/08/2018
End Date (please select the first day of the month if you do not recall the exact date) 12/27/2019
Describe work performed and scope of responsibilities. * Load truck with materials unload water bottles to customers homes businesses company cleaning trucks and make sure customers are happy
May we contact this employer? Yes
Click the forward arrow at the bottom to continue. Education History
To add additional education, click the Add Education button below. The Remove Last Education will delete all entries for the last education that you have entered. Please enter your highest level of education first.
*= System Required
*= Conditionally Required based off previous answer Education 1
Education Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . High School Graduate School/University Name * Egg Harbor Township High School Did you graduate? * Yes
City * Egg Harbor Township
Country * United States
State/Province * New Jersey
Major/Field of Study * General Business
Click the forward arrow at the bottom to continue. eSignature
Please read, sign, and acknowledge where applicable, then click on the forward arrow to continue with the process I certify that all the information I have provided on this application is true and complete to the best of my knowledge. I understand that omitting requested information or giving false or misleading information on my application (even if I believed the information to be true), in my interview(s), or in the process of my pre-employment evaluation may result in rejection of my application or termination of employment. I authorize the Company to verify the information I have provided in this application and, if I am hired, I authorize continuing investigation of all statements contained in this application, consistent with applicable law. I understand that employment and continued employment is subject to satisfactory completion of a background check and proof of my authorization to work in the United States, all conducted and/or required in accordance with applicable laws. Past conviction of a crime is not an automatic bar to employment. The nature, time since conviction, disposition of conviction and other factors deemed relevant by the Company for the position will be considered as it relates to the job you are seeking and consistent with applicable law. To the maximum extent permitted by law, I hereby release and hold harmless all persons and entities, including my present employer, requesting or supplying information about my background and, to the maximum extent permitted by law, I also release the Company and any contractor or vendor retained by the Company from all liability in connection with the conduct of a background check in connection with my application for employment. Notwithstanding the foregoing, I understand that this Application of Employment does not constitute an offer of employment by the Company. Employment with the Company is for an indefinite and unspecified duration. If I am hired, I may leave employment at will, and the Company may discharge me or any or all other employees at any time, without notice, and for any reason not prohibited by law.
I agree that any claim or lawsuit relating to my application for employment and, if applicable, employment or termination from employment with the Company must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitation to the contrary to the maximum extent permitted by law. I acknowledge that I have carefully read all of the above, acknowledge and understand what I am signing. I understand that an electronic signature has the same effect and validity as a written signature.
eSignature
Please type your name in the acknowledgement box below as follows: Robert L Gilford Then select Accept to continue. Selecting Decline means you do not accept and you will not be able to continue with the application process. Acknowledgement .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Robert L Gilford
Accepted
FOR ARIZONA APPLICANTS: PURSUANT TO ARIZ. REV. STAT § 36-601.01, THE COMPANY MAINTAINS A SMOKE-FREE WORKPLACE. FOR RHODE ISLAND APPLICANTS: THE COMPANY IS SUBJECT TO CHAPTER 29-38 OF TITLE 28 OF THE GENERAL LAWS OF RHODE ISLAND AND IS THEREFORE COVERED BY THE STATE'S WORKERS' COMPENSATION LAW.
FOR MASSACHUSETTS APPLICANTS: I ACKNOWLEDGE THAT IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
I acknowledge the above statement
No
FOR MARYLAND APPLICANTS: I ACKNOWLEDGE THAT, UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. I acknowledge the above statement
No
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