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Authorization

I hereby certify, under the penalty of perjury in the State of Texas, that this application contains no willful misrepresentation and that the information given is true and complete to the best of my knowledge and belief. I understand that falsification of this application will be grounds for elimination from further consideration or, if employed, for dismissal at anytime. I authorize my previous employers and all schools or educational and technical institutions which I have attended to furnish Roasters Coffee & Tea Co. ® my record, reason for leaving and all information they may have concerning me. I hereby release any such current or former employers or institutions, their agents or employees and Roasters Coffee & Tea Co. ® from all liability for any damage whatsoever arising therefrom. I authorize investigation of all statements in this application.