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 *
Employment Positions
When can you start? *

Month Day Year
Date
Are you applying for *

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

Case Manager Office Staff Human Resources
Employment History
Were you at anytime employed by an Indiana State agency or an agency affiliated with the State of Indiana?
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
Professional References
First Name
Last Name
Email Address
Phone
First Name
Last Name
Email Address
Phone
First Name
Last Name
Email Address
Phone
Education, Training, and Experience
High School Name, Address, Years Completed
Did you graduate? *

Yes No
College/University

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

Yes No
Degree (s) earned and Major and Minor (if achieved) *
Have you been convicted for any crime, including sex related or child abuse related offenses? *

Yes No
Have you applied to Unity of Indiana previously?
If yes, please specify the date of previous application:

Month Day Year
Date
Documentation
Please complete and upload a check via MyCase.In.gov:

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