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APPLICATION FOR EMPLOYMENT

LUBY’S FUDDRUCKERS RESTAURANTS, LLC

PERSONAL INFORMATION (please print clearly or type)

Name

Date

____________________________________________________________________________________ Last First Middle

______________

Present Address

_

Street Address

Apt #

______________________________________________________________________________________

City

State

Zip Code

Phone # (______) _________________

Social Security#_______________________

DL#______________________________

Type of driver’s license __________________ In case of an emergency notify:

State Issued

______

Restrictions

___________________________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name

Relationship

__________________________________________________________________________________________

Address

Phone

How did you learn about Luby s Fuddruckers job opportunities: (please circle)

Newspaper

Banner

Marquee

Texas Workforce Commission

Walk-in

On-line

Luby’s Web Site

F r i e n d ( N a m e ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Relative (Name)

_________________________________________________

Other

_______________________________

Have you ever been employed by Luby’s before? Yes

  • No Where / When?

__________________________________

Luby's Fuddruckers requires employees to work schedules that vary in hours and days of the week.

Can you comply with this policy?

  • Yes

  • No

If no, explain:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Number of hours desired________Full-time or part-time

_________

Are you willing to work overtime if needed? Yes No

Please list any hours you are NOT available to work.____________

What date are you available to start working? ________

Some of our positions require that you be 18 or older. If hired for one of these positions, can you show proof of age?

  • Yes

  • No

Are you authorized to work in the U.S. on an unrestricted basis? Yes No

Check the position/s you are applying for:

M a i n O f f i c e ( p l e a s e s p e c i f y ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ C o n t r a c t / C u l i n a r y S e r v i c e s ( p l e a s e s p e c i f y ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Other (please specify):

________________________________________________________________________

CREW / ASSOCIATE: (please circle) Butcher

Cook

Checker

Cashier

Counter

Dishwasher

Porter

Waitstaff Service

Attendant

Fill In

Food to Go

Supervisor / Breakfast

Salad

Vegetable Prep

Have you been diagnosed with, have been exposed to and/or live with anyone who has been diagnosed with the following:

Circle:

Hepatitis A

Shigelle

E. Coli

Salmonelle

Norovirrus

Do you have a current health card? Yes

  • No

HR Form No. 201(revised 09/2002, 08/2007, 09/2010) Emp App

Equal Opportunity Employer

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