Lewis Drug: Apply Online

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Online Application for Employment
*Date: (07/31/2010)
*First Name:
*Last Name:
*Street Address:
*City, State, Zip Code:
*Social Security Number:
*Phone Number:
*Are you between 16 and 75?		Yes No
*How long have you been a resident of South Dakota?
Are you a citizen of the US?		Yes No
If not, do you have a work visa?		Yes No
Who suggested that you apply for a position here?
*Have you ever been convicted of a crime involving dishonesty or a breach of trust?		Yes No
*Have you ever applied for bond?		Yes No
*Were you ever refused bond?		Yes No
List any friends or relatives working for us:		characters remaining
Please list the name and adress of the person to be notified in case of accident or emergency.
*Name:
*Address:
*Phone Number:

Online Application for Employment