APPLICANT STATEMENT
Please Read Carefully Before Signing
HX5, LLC is an equal opportunity employer. HX5, LLC does not discriminate in employment on account of
race, color, religion, national origin, citizenship status, ancestry, age, gender, 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 HX5, LLC to hire me. If I am hired, I understand that either
HX5, 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 HX5, LLC has the authority to make any
assurance to the contrary.
I hereby authorize HX5, LLC and its designated agents and representatives to conduct a comprehensive
review of my background causing a consumer report and/or an investigative consumer report to be
generated for employment purposes. I understand that the scope of the consumer report/ investigative
consumer report may include, but is not limited to the following areas: verification of social security
number; credit reports, current and previous residences; employment history, education background,
character references; drug testing, civil and criminal history records from any criminal justice agency in
any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.
I understand that, pursuant to the federal Fair Credit Reporting Act, HX5, LLC will provide me with a copy
of any such report if the information contained in such report is, in any way, to be used in making a
decision regarding my fitness for employment with HX5, LLC. I further understand that such report will
be made available to me prior to any such decision being made, along with the name and address of the
reporting agency that produced the report.
I attest with my signature below that I have given to HX5, LLC true and complete information on this
application. No requested information has been concealed. I authorize HX5, LLC to contact references
provided for employment reference checks. If any information I have provided is untrue, or if I have
concealed material information, I understand that this will constitute cause for the denial of
employment or immediate dismissal.
Candidate Sign Off
I certify that all of the information in this application is true and correct as of this date.
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