APPLICATION FOR EMPLOYMENT

LUBY'S FUDDRUCKERS RESTUARANTS, 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 State issued Restrictions

in case of emergency notify:

NAME Relationship

Address Phone

How did you learn about Foddruckers job opportunities (please circle)

Newspaper Barner Marquee Taxes Workforce COMMISSION walk-in On-line Luby's website

Friend (Name)

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 weeks

Can you comply with policy? YES NO if no, explain:

Numbers of hours desired Full-time/part-time Are you willing to work overtime if needed? YES NO

Please list any hours you are NOT allow 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 basics? YES NO

Check the position's you are applying for:

Main Office (please specify)

Contract/Cuinary services (please specify)

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 Hepatilis A Shigrile E coil Salmonlle Noravirus Do you have a health card? YES NO