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I hereby certify that the foregoing statements are true and correct and I understand that any false statement or omission may be considered as sufficient cause to reject this application or for dismissal from employment if such false statement or omission is discovered subsequent to the beginning of my employment. I release Luby’s from any and all liability arising from the release of any information contained on this application to 3rd parties. I further understand that during the course of my employment, Luby’s may elect to obtain an “investigative consumer report,” as defined by the Fair Credit Reporting Act (FCRA). This consumer report may include, but not be limited to, my personal background and credit information through credit agencies, records search, or other sources for purposes related to this application for employment or my continued employment including hiring, promotion, transfer, reassignment, or retention. In the event that I am employed, I agree to comply with all company policies and standards and understand that attendance is an essential function of any job at Luby’s. I acknowledge that Luby’s policies prohibit harassment and discrimination of any kind and that, if hired, I must report any instances of harassment or discrimination of which I am aware. I also understand that the use of illegal drugs or alcohol on the job is prohibited during employment.

Signature of Applicant

Date

Manager taking application_____________________________________________________________________________

Was applicant hired?

  • Yes

  • No

This application will remain in active file for 90 days. This information must be kept on file for 2 years.

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

Equal Opportunity Employer

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