Special Questions

This information is:

• required for bona-fide occupational qualifications
• dictated by national security laws
• needed for other legal permissible reasons

Graduate School

Trade, Business or
Correspondence School

*The Age Discrimination Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40yrs of age.

Military

In case of emergency, please notify:

LIMITED CRIMINAL HISTORY/STATE NURSES AID REGISTRY

In accordance w/ State regulatory boards Abilities Services, Inc. shall obtain a limited criminal history for each employee, officer, or agent involved in the management, administration, or provision of services.

The limited criminal history shall verify that the employee, officer, or agent has not been convicted of the following:

1. A sex crime.
2. Exploitation of an endangered adult.
3. Failure to report:
   • battery, neglect, or exploitation of an endangered adult; or
   • abuse or neglect of a child.
4. 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 IC 16-27-2-5(a)(5).
5. Murder
6. Voluntary manslaughter
7. Involuntary manslaughter
8. Felony battery
9. A felony offense relating to a controlled substance.

A provider shall have a report from the state nurse aid registry of the Indiana state department of health verifying that each employee or agent involved in the management, administration, and provision of services has not had a finding entered into the state nurse aide registry (Division of Disability, Aging, and Rehabilitative Services, 460 IAC 6-10-5, filed Nov 4, 2002, 12:04 p.m.: 26 IR 768)

** You will not be denied employment solely because of a conviction record, unless the offense is one of those above.

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INVITATION TO IDENTIFY FOR AFFIRMATIVE ACTION

The Company is an Equal Employment Opportunity (EEO) employer and does not discriminate in any employer/employee relations based on race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran's status or any other basis protected by applicable discrimination laws.  This company is required by Federal regulations to report information as requested below.  Your contribution of this information is completely voluntary and is in no way affects the decision regarding your employment opportunity.  The information you provide is strictly confidential and will be maintained separate from your application form.

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Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I Authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time, without prior notice.”
 

Send us your resume, too.

If you wish to include your resume, please click the link and email it to

opportunities@asipages.com.

Then, be sure to submit the online application (click SUBMIT, below).