Thank You for Applying

Jucy'sâ

HAMBURGERS

THANK YOU FOR APPLYING!

Thank you for your interest in working for Jucy’s Hamburgers. Here at Jucy’s we want you to know that we believe providing quality service and products is the key to being successful. Our employees enjoy providing their customers with the same kind of service they like to receive — friendly and fast. And they make certain our customers receive quality food in a clean environment. They understand this is everyone’s responsibility, from the entry-level employee to the owner of the company.

We believe our employees are our greatest assets. Because of this, we take the selection and hiring process very seriously. We will call all of your previous employers and perform extensive reference checks. We do all of this because, as your prospective employer, we are considering two very important questions:

· Is this the right position for you?

· Are you the best applicant for the position?

As your potential employer, we will consider you on the basis of your employment application, prior work experience, pre-employment evaluations, and references. After reviewing your paperwork, we may contact you to set up an interview.

Remember, we are trying to find a good match between the applicant and the position so that everybody benefits. If the position is not right for you, do not be discouraged, but realize you are avoiding a negative work experience.

Again, thank you for applying with our organization. We wish you the best of luck in your job search.

Equal Opportunity Employer

Jucy’s Marshall L.L.C.

Federal law prohibits discrimination on the basis of race, color, religion, disability, sex, or national origin, as well as discrimination on the basis of age against persons over the age of 40. Some state and city legislation prohibits discrimination on the basis of age, marital status, sexual preference, race, color, religion, sex, national origin, or any other basis prohibited by law. This employment application is only active for 30 days. After this time period a separate employment application must be submitted in order to be considered for employment.

PLEASE PRINT CLEARLY Date________________________

PERSONAL

Name Social Security Number

First Middle Last

Address

Street City State Zip

List any other names you have worked under:

Phone Number with Area Code Salary Expected Are you at least 16 years old?

( )

Yes No

List any friends or relatives employed by this company:

Are you legally eligible for employment in the U.S.? Yes No (Proof of U.S. citizenship or immigration status will be required if hired for a position in the U.S.)

EMPLOYMENT DATA

Are you seeking: Temporary Full-time Part-time What position(s) are you applying for?

How did you find out about this job? Newspaper Referral Other Where?

Are you willing to work overtime? Yes No Weekends? Yes No Holidays? Yes No

If hired, do you have a reliable means of transportation to get to work? Yes No What is it?

Are you currently employed? Yes No If hired, when would you be able to start?

Are you on layoff and subject to recall? Yes No If yes, explain:

Have you ever been discharged or asked to resign from any position? Yes No If yes, please described:

How many days have you missed or been late to school or work within the last 12 months for reasons other than personal sickness? Days: Explain:

Have you been convicted of a felony in the last seven years? Yes No On parole? Yes No

Awaiting trial? Yes No Deferred Adjudication? Yes No If yes, state the nature of the offense and disposition of the case. Include dates and places. Note: Felony convictions or the existence of a criminal record do not constitute an automatic bar to employment.

EDUCATION (Please circle highest level attained)

Elementary High School College

1 2 3 4 5 6 7 8 9 10 11 12 G.E.D. 1 2 3 4 5 6 7 8

Name of School Name of School Name of School

Location of School Location of School Location of School

If currently in high school, are you enrolled in a recognized co-op program (such as Degree and Major:

D.E., C.V.A.)? Yes No If yes, identify program and school:

Date Graduated:

MILITARY SERVICE

Are you a veteran? Yes No Dates of service: From: To:

Special skills or training:

WORK HISTORY

Please list your last four employers. Begin with the most recent. (If you have had more than four jobs in the last five years, attach another sheet.)

Company Address Phone From To

Mo. & Yr. Mo. & Yr.

Job title Specific reason for leaving Supervisor’s name and title

Describe duties briefly Starting salary Ending salary

Company Address Phone From To

Mo. & Yr. Mo. & Yr.

Job title Specific reason for leaving Supervisor’s name and title

Describe duties briefly Starting salary Ending salary

Company Address Phone From To

Mo. & Yr. Mo. & Yr.

Job title Specific reason for leaving Supervisor’s name and title

Describe duties briefly Starting salary Ending salary

Company Address Phone From To

Mo. & Yr. Mo. & Yr.

Job title Specific reason for leaving Supervisor’s name and title

Describe duties briefly Starting salary Ending salary

May we contact all of these employers? Yes No If not, tell us which one(s) you do not wish us to contact and why.

Have you ever worked for this organization before? Yes No If yes, list all locations to which you were assigned:

If yes, who was your last immediate supervisor when working here?

If hired, how long to you plan on working for this organization?

If hired, why would you quit your job with this organization?

PLEASE LIST THE NAMES AND TELEPHONE NUMBERS OF THREE PEOPLE, NOT RELATED TO YOU, WHOM YOU HAVE KNOWN FOR AT LEAST ONE YEAR.

Name Telephone Number

PLEASE READ THE FOLLOWING WAIVER CAREFULLY, INITIAL EACH STATEMENT, THEN SIGN AND DATE THE APPLICATION.

I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations that supply such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. Upon my formal written request, within a reasonable period of time, I will be notified as to the nature and scope of such investigations.

I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a physical examination, post-job offer, and employment will be conditional upon passing such examination. During such employment, I understand and agree that, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job related, I hereby authorize the limited release and exchange of such medical information relating to my condition between treatment provider and a company-designated physician.

The company reserves the right to submit all employment disputes to binding arbitration.

I have read and understand the above.

__________________________________________________________ __________________________________

Signature Date