As an applicant for employment with Ted Berry Co., Inc., I certify that the information contained in this application is correct and that I have not omitted any information. I understand that falsification or omission of information may result in the rejection of my application, or if employment commences, immediate dismissal.

I authorize Ted Berry Co., Inc. to contact former employers and educational organizations regarding my employment and education. I authorize all schools, references, employers and any other person to provide my complete record, reason for leaving, and all other information they may have concerning me including my personal character, habits, and employment records. I hereby release all such persons from any and all liability or claims for damage whatsoever that may result from responding to any inquiry or furnishing any information.

I understand that nothing contained in this application or in the granting of an interview creates a contract between Ted Berry Co., Inc. and me for either employment or for the providing of any benefits. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon Ted Berry Co., Inc. unless made in writing by the President, Ted Berry Co., Inc. If an employment relationship is established, I acknowledge that no consideration has been furnished to Ted Berry Co., Inc. for my employment other than my services.

I agree and acknowledge that my employment can be terminated, with or without cause or notice, at any time by Ted Berry Co., Inc. or myself. I further agree and acknowledge that no representative other than the President, Ted Berry Co., Inc. has the authority to make any oral or written agreements for employment for a specified time or for specific conditions of my employment. I further agree and acknowledge that any agreement for employment for a specified period of time or specific conditions of my employment must be in writing and signed by the President, Ted Berry Co., Inc. and me.

I understand that if I am selected for employment I will be required to verify, within three days of my date of hire, my identity and eligibility to work as required under the Immigration Reform and Control Act of 1986. I understand that this requirement applies to all new employees including U.S. citizens, permanent residents and non- immigrants.

I acknowledge that I have been informed that a routine pre-employment physical exam to be conducted by a health facility, medical clinic or physician selected and paid for by Ted Berry Co., Inc. is required following an offer of employment. Any medical problems identified during the physical exam that are directly related to the ability to perform assigned duties may result in the withdrawal of a previously extended job offer, or dismissal if already employed.

I acknowledge that I have been informed that a pre-employment urinalysis, or other medical examination for controlled substances and drugs, to be conducted by a health facility, medical or testing clinic or laboratory or physician selected and paid for by Ted Berry Co., Inc. is required following an offer of employment. I agree to submit to such examination or tests and hereby authorize the release and disclosure of the result to Ted Berry Co., Inc. I further acknowledge that any test results which show the presence of a controlled substance, without a medically acceptable prescription, or illegal drug will result in the withdrawal of a previously extended job offer, or dismissal if already employed.

I agree to sign any documents that may be necessary to permit such release of and disclosure to Ted Berry Co., Inc. of any medical examination or medical tests for controlled substances or drug abuse. I further agree that if employed, I will be subject to the terms of the Ted Berry Co., Inc. substance abuse policy.

My signature attests that I have carefully read and understand the information contained in this certification. I further declare and certify that the entries set forth on this application and on other documents provided by me to Ted Berry Co. Inc. are true and accurate.