o NoneEntity Type
0001499717
Golden Fork Corp.
GOLDEN FORK CORP
 
x Corporation
o Limited Partnership
o Limited Liability Company
o General Partnership
o Business Trust
o Other
Name of Issuer
 Staffing 360 Solutions, Inc.
Jurisdiction of Incorporation/OrganizationDELAWARE 
Year of Incorporation/Organization
  x Over Five Years Ago
  o Within Last Five Years (Specify Year)  
  o Yet to Be Formed 



2. Principal Place of Business and Contact Information
Name of Issuer 
 Staffing 360 Solutions, Inc. 
Street Address 1Street Address 2
 641 Lexington Avenue Suite 2701
CityState/Province/CountryZIP/Postal CodePhone No. of Issuer
 New York NEW YORK 10022 646-507-5710 



3. Related Persons
Last NameFirst NameMiddle Name
FloodBrendan
Street Address 1Street Address 2
641 Lexington Avenue, 27th Floor
CityState/Province/CountryZIP/Postal Code
New YorkNEW YORK10022
Relationship: x Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
 Chairman, Chief Executive Officer, President and Director

Last NameFirst NameMiddle Name
FaimanDavid
Street Address 1Street Address 2
641 Lexington AveSuite 2701
CityState/Province/CountryZIP/Postal Code
New YorkNEW YORK10022
Relationship: x Executive Officer o Director o Promoter
Clarification of Response (if Necessary)
 Chief Financial Officer, Executive Vice President and Treasurer

Last NameFirst NameMiddle Name
BarkerAlicia
Street Address 1Street Address 2
641 Lexington AveSuite 2701
CityState/Province/CountryZIP/Postal Code
New YorkNEW YORK10022
Relationship: x Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
 Chief Operating Officer and Director

Last NameFirst NameMiddle Name
FlorioNicholas
Street Address 1Street Address 2
641 Lexington AveSuite 2701
CityState/Province/CountryZIP/Postal Code
New YorkNEW YORK10022
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
 Director

 
Last NameFirst NameMiddle Name
GroutJeff
Street Address 1Street Address 2
641 Lexington AveSuite 2701
CityState/Province/CountryZIP/Postal Code
New YorkNEW YORK10022
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
 Director

Last NameFirst NameMiddle Name
VillardDimitri
Street Address 1Street Address 2
641 Lexington AveSuite 2701
CityState/Province/CountryZIP/Postal Code
New YorkNEW YORK10022
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
 Director

 


4. Industry Group
o Agriculture Health Care o Retailing
 Banking & Financial Services   o Biotechnology o Restaurants
  o Commercial Banking   o Health Insurance Technology
  o Insurance  o Hospitals & Physicians  o Computers
  o Investing  o Pharmaceuticals  o Telecommunications
  o Investment Banking  o Other Health Care  o Other Technology
  o Pooled Investment Fund

    Travel
  o Other Banking & Financial Services o Manufacturing  o Airlines & Airports
 Real Estate  o Lodging & Conventions
  o Commercial  o Tourism & Travel Services
  o Construction  o Other Travel
  o REITS & Finance x Other
  o Residential 
  o Other Real Estate 
o Business Services 
 Energy 
  o Coal Mining 
  o Electric Utilities 
  o Energy Conservation 
  o Environmental Services 
  o Oil & Gas 
  o Other Energy 


5. Issuer Size
Revenue RangeAggregate Net Asset Value Range
o No Revenues o No Aggregate Net Asset Value
o $1 - $1,000,000 o $1 - $5,000,000
o $1,000,001 - $5,000,000 o $5,000,001 - $25,000,000
o $5,000,001 - $25,000,000 o $25,000,001 - $50,000,000
o $25,000,001 - $100,000,000 o $50,000,001 - $100,000,000
o Over $100,000,000 o Over $100,000,000
x Decline to Disclose o Decline to Disclose
o Not Applicable o Not Applicable


6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
o Rule 504(b)(1) (not (i), (ii) or (iii)) o Rule 505
o Rule 504 (b)(1)(i) x Rule 506(b)
o Rule 504 (b)(1)(ii) o Rule 506(c)
o Rule 504 (b)(1)(iii) o Securities Act Section 4(a)(5)
  o Investment Company Act Section 3(c)

7. Type of Filing
x New Notice Date of First Sale 2019-11-11 o First Sale Yet to Occur
o Amendment

8. Duration of Offering
Does the Issuer intend this offering to last more than one year? o Yes x No

9. Type(s) of Securities Offered (select all that apply)
o Pooled Investment Fund Interests x Equity
o Tenant-in-Common Securities o Debt
o Mineral Property Securities o Option, Warrant or Other Right to Acquire Another Security
o Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security o Other (describe)
  


10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? o Yes x No
 
Clarification of Response (if Necessary) 
  

11. Minimum Investment
Minimum investment accepted from any outside investor$ 0 USD

12. Sales Compensation
RecipientRecipient CRD Number o None
  
(Associated) Broker or Dealer o None(Associated) Broker or Dealer CRD Number o None
  
Street Address 1Street Address 2
  
City State/Province/CountryZIP/Postal Code
   
State(s) of Solicitation o All States
 
 



13. Offering and Sales Amounts
Total Offering Amount $ 92000 USD o Indefinite
Total Amount Sold $ 92000 USD 
Total Remaining to be Sold $ 0 USD o Indefinite
 
Clarification of Response (if Necessary)
 Represents 100,000 common shares issued to Jackson Investment Group ("JIG") pursuant to JIG's waiver of issuer's non-compliance under outstanding notes. The offering amount is calculated based on the 11/11/19 closing price of the issuer's common stock.


14. Investors
o Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors,
Number of such non-accredited investors who already have invested in the offering
 
  Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: 1


15. Sales Commissions & Finders’ Fees Expenses
Provide separately the amounts of sales commissions and finders' fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions$ 0 USD o Estimate
Finders' Fees$ 0 USD o Estimate
 
Clarification of Response (if Necessary)
  


16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
 $ 0 USD o
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