OKLAHOMA CHRISTIAN UNIVERSITY APPLICATION
Insert B (To be completed only if applicant has a conviction)
CONVICTION DETAIL
Print Name:____________________________________________________________________
Date of Birth: _____________ SS#: ____________________ Drivers License #: ____________
Home Phone: _____________________ How long at current address? _____________________
Current Address:
Street City State Zip County
You are required to provide full, accurate and complete information on your criminal conviction history upon
application for employment. Refusal to complete these documents or providing false information shall result in
refusal of employment. The term conviction includes a determination of guilty by a trial, by a plea of guilty, or a
plea of no contest.
Convictions, Guilty or No Contest Pleas, and/or Deferred Judgments, or Adjudications
Date (mm/yyy): ________________________________________________________________________________
Location (city, state): ___________________________________________________________________________
Type of offense: _______________________________________________________________________________
Name of court: ________________________________________________________________________________
Nature of offense: ______________________________________________________________________________
Date (mm/yyy): ________________________________________________________________________________
Location (city, state): ___________________________________________________________________________
Type of offense: _______________________________________________________________________________
Name of court: ________________________________________________________________________________
Nature of offense: ______________________________________________________________________________
I certify that the statements made by me in this section are true, complete and correct to
the best of my knowledge and belief and are made in good faith. I understand that any
false statements made herein, including omissions, will void my application and any actions
based on it and I will not be eligible for future employment with Oklahoma Christian
University.
_______________________________ ___________________________ ___________________
Print Name Signature Date
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