APPLICATION FOR EMPLOYMENT
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BI-COUNTY SERVICES, INC.
425 East Harrison Road
Bluffton, IN 46714
260-824-1253

Equal Opportunity Employer – Bi-County Services, Inc. will recruit, hire, train and promote persons in all job titles without regard to race, color, religion, national origin, veteran status, sex, age, or physical or mental disability.

In addition, Bi-County Services, Inc. employment policy requires compliance with state and local fair employment practice laws and regulations. Bi-County Services, Inc. will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities so long as doing so does not cause an undue hardship.

The information provided in this Application for Employment is true, correct and complete. If employed, I understand that falsification, misrepresentation, incomplete information or omission of facts called for on this application will result in termination.

Incomplete applications will not be considered.
  • Contact Information

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  • Part time is only available for Supported Living/Day Service positions
  • check all that are applicable
  • If you are offered employment with Bi-County Services, Inc., you will be required, by federal law, to furnish documents showing you to be either a U.S. citizen or an authorized alien. Individuals who do not furnish these documents cannot work for this agency.

  • Education

    Education will be considered only to the extent relevant for the position for which you are applying.
  • Employment History

    Most recent employer first-include all employers for the last 5 years. Explain any gaps in employment on reverse side. If past employment is recorded under a different last name – please include with information below.
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  • Personal References (list three)

    Not Relatives or Anyone Previously Mentioned
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  • I hereby authorize anyone of whom request is made to supply Bi-County Services, Inc., any information concerning my background in connection with employment consideration. I hereby release all parties, including but not limited to Bi-County Services, Inc. and my prior employers, from any and all liability for any damage that may result from their furnishing information concerning me.

    I understand and hereby acknowledge that if I am offered and accept employment with Bi-County Services, Inc. my employment is considered at-will, is for no definite period of time, and may be terminated with or without cause.

    I further understand that this application for employment is not a contract of employment. I understand that if I am employed, I must be free from communicable disease, which would pose a direct threat to the health or safety of others or myself in the workplace that cannot be eliminated by reasonable accommodation.

    I authorize Bi-County Services, Inc. to request and obtain from any law enforcement agency, a copy of my limited criminal history information and a copy of my driving record through the Indiana BMV in connection with my application for employment.

    If employed, it will be conditional until the final step in the employment process is completed. Within thirty (30) days, you will be required to submit to a drug screen test. If you do not complete the test as requested or if the test is positive, employment will be terminated.
  • We will keep your application on file for 90 days. After that time, you will need to submit a new application for employment consideration.
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  • Criminal Background Check
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    As a part of this application for employment, I hereby authorize Bi-County Services, Inc. to request/obtain limited criminal history from my counties of residence during the past three years and from the State of Indiana.

    The county limited criminal history we obtain will request felony conviction (that has not been expunged by a court) of the following:

    - Sex crime

    - Battery

    - Neglect

    - Exploitation of an endangered adult or of a - Failure to report Battery, Neglect or Exploitation of an endangered adult or of a child, or failure to report abuse or neglect of a child

    - Theft, if the person’s conviction for theft occurred less than ten (10) years before the person’s employment application date, except as provided in IC16-27-2-5(a)(5)

    - Criminal conversion

    - Criminal deviate conduct

    - Murder

    - Voluntary manslaughter

    - Involuntary manslaughter

    - Offense relating to alcohol or a controlled substance

    Bi-County Services, Inc. provides services to a vulnerable population. If there are finding in the criminal history, an individualized assessment will be use to make an employment decision.
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