Please read carefully before signing.

Empirical Prime, LLC, (company name as listed in this application includes reference for any of it's subsidiaries), is an equal opportunity employer. Empirical Prime, LLC does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Empirical Prime, LLC to hire me. If I am hired, I understand that either Empirical Prime, LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Empirical Prime, LLC has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Empirical Prime, LLC and its subsidiaries, true and complete information on this application. No requested information has been concealed. I authorize Empirical Prime, LLC to perform a complete background check, including but not limited to information provided by credit reporting agencies, investigative consumer reports that may include my creditworthiness or similar characteristics, employment and education verifications, verbal and written inquiries or information about my employment performance, professional demeanor, rehire potential, dates of employment, salary and employment history, social security verification, criminal and civil history, personal interviews, DMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics and trustworthiness, contacting references provided, and using E- Verify. I knowingly and voluntarily release all former and current employers, references, and Empirical Prime, LLC (and its subsidiaries) from any and all liability arising from their giving or receiving information about my employment and credit history. If any information I have provided is found to be untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. This form may be photocopied or reproduced as a facsimile, and these copies will be as effective as a release or consent as the original which I sign.