Employment Application

Employment Application
Unity of Indiana is an equal opportunity employer. This application will not be used for limiting or excluding and applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization at 317-888-1481.
Your Contact Information
First and Last Name
Current Address
City, State, and Zip
County of Residence:
Email Address
Phone
Phone Number

Area CodePhone Number
Employment Positions
When can you start?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you applying for
What are your salary requirements?
Which position are you applying for?
Employment History
Were you at anytime employed by an Indiana State agency or an agency affiliated with the State of Indiana Have you ever been issued a Indiana Peoplesoft ID ?
If the above response was yes, then documentation stating you left the position in good standing from that employer will be required.
If yes, did you leave in good standing?
Are you currently employed?
Name of Employer
Name of Supervisor
Reason for Leaving
Telephone Number
Business Type
Address, City, State, Zip
Length of Employment
Position and Duties
Reference contact to confirm current employer
First Name
Last Name
Email Address
Phone
QMRP / QIDP qualifications are regulated under the Indiana Administrative Code (410 IAC 16.2-1.1-55). To qualify, an individual must have specialized training or at least one year of experience treating or working directly with individuals who have intellectual or developmental disabilities, combined with one of the state's recognized professional credentials.

Reference to Confirm DD Experience

*IAC 460.6 requires at least one year of direct, documented experience working with individuals with intellectual or developmental disabilities.
Briefly describe your experience working with the DD Population.
First Name
Last Name
Email Address
Phone
Education, Training, and Experience
High School Name, Address, Years Completed
Did you graduate?
College/University

*IAC 460.6 requires 4 year College Degree for Case Management
School Name, School, Address, Years Completed
Did you graduate?
Degree (s) earned and Major and Minor (if achieved)
Have you been convicted for any crime, including sex related or child abuse related offenses?
Have you applied to Unity of Indiana previously?
If yes, please specify the date of previous application:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Documentation
Please complete and upload a check via MyCase.In.gov:

Browse Files

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Please attach resume:

Browse Files

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How did you hear about Unity of Indiana?
Were you referred to Unity of Indiana ? If so by whom ?
Background Check Authorization

I, the undersigned, hereby authorize Unity of Indiana and its designated agents to conduct a background check as part of the employment application process. This may include, but is not limited to, verification of identity, employment history, education, and criminal records.

I understand that the information obtained will be used solely for employment purposes and that a consumer report may be obtained. I release Unity of Indiana and all parties providing information from any liability arising from this inquiry.

By signing below, I confirm that the information I have provided is accurate and that I have read and understand this authorization.
Full Legal Name

First NameLast Name
Other Known/Maiden Names
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
123-45-6789
Signature
I am currently not under the restrictions of a non-compete agreement with any employer.
Unity of Indiana strives for initial training excellence during the first 90-day Probationary Period. If you are aware of and can commit to the full 90 days of initial training, please mark the appropriate box.
Signature
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