Consumer Report

DISCLOSURE AND AUTHORIZATION

REGARDING BACKGROUND INVESTIGATION

DISCLOSURE. Circle K Stores, Inc., its subsidiaries, affiliates, other related entities, successors, and/or assigns, may obtain a consumer report about you from a third-party consumer reporting agency, including an investigative consumer report containing information as to your character, general reputation, personal characteristics, and mode of living, for employment purposes.

AUTHORIZATION. By signing this document, you hereby authorize Circle K Stores, Inc., its subsidiaries, affiliates, other related entities, successors, and/or assigns, to obtain a consumer report about you. Signature: Date: