Fillable Conflict Of Interest Disclosure

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Conflict Of Interest Disclosure

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  • 4 check-boxes
  • 12 other fields

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File type: PDF

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ORAL ROBERTS UNIVERSITY
CONFLICT OF INTEREST DISCLOSURE STATEMENT
TO: Director of Human Resources (Staff)
Provost (Faculty)
Please check one below:
o I am not currently engaged in any activities which may be construed as a conflict
of interest with my responsibilities at the university, nor is any member of my
immediate family.
o I am (or an immediate family member is) engaged in the following activities or
have a relationship with the following vendors, suppliers, or contractors of the
university. Explain:
o I anticipate the following prospective activities and material interests for which a
potential conflict of interest may exist. Explain:
o I have a relative working at ORU. If yes,
Name of relative working at ORU: ____________________________________
What department do they work in? ____________________________________
Name of their supervisor: ___________________________________________
_________________________
Employee’s Printed Name
_______________________________________ ____________
Employee’s Signature Date
________________________________________ _____________
Department Mgr./Head/Chair Date
________________________________________ _____________
Dean/Vice President Date
________________________________________ _____________
Vice President/Provost/CFO/COO Signature Date
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Conflict Of Interest Disclosure

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Completed 25 February 2020

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