Employment Application

Employment Application
EOE
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
Date
Are you applying for*

Full TimePart Time
What are your salary requirements?*
Which position are you applying for?*

Case ManagerSupervisorQuality AssuranceOther
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
Briefly describe your experience working with the DD Population.
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.
First Name
Email Address
Last Name
Phone
Education, Training, and Experience
High School Name, Address, Years Completed
Did you graduate?*

YesNo
College/University

*IAC 460.6 requires 4 year College Degree for Case Management
School Name, School, Address, Years Completed*
Did you graduate?*

YesNo
Degree (s) earned and Major and Minor (if achieved)*
Have you been convicted for any crime, including sex related or child abuse related offenses?*

YesNo
Have you applied to Unity of Indiana previously?
If yes, please specify the date of previous application:

MonthDayYear
Date
Documentation
Please complete and upload a check via MyCase.In.gov:

Browse Files

Cancelof
Please attach resume:

Browse Files

Cancelof
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.

YesNo
Signature
Should be Empty: