(PROOF OF ELEGIBILITY IS REQUIRED UPON EMPLOYMENT )

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby certify that I am drug free and acknowledge that if employed I give permission to random drug tests as required to maintain employment.

I hereby authorize the company, and any agent its designates, to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that the company has installed or may install surveillance cameras in the restaurant for safety and security purposes and may otherwise video-tape and/or record my performance and interaction with others in the restaurant for training and evaluation purposes. By signing below, I give my consent to such surveillance, video-taping and recording.

I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company ’s President.

Kiwi Café & Smoothies is and equal opportunity employer. Applicants for all job openings

are welcome and will be considered without regard to race, sex, age, religion, national origin,

color, disability, citizenship or veteran status or any other basis protected by law.

kiwicafeandsmoothies.com | 919.570.5001

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