An Equal Opportunity/Affirmative Action Employer
EAST CENTRAL UNIVERSITY, ADA, OK
Disclosure to Employment Applicant
I hereby authorize East Central University (ECU) to contact any and all corporations, former employers, educational
institutions, law enforcement agencies and military services to release information about my background including, but
not limited to, information about my employment, education, driving record, criminal record and general public records
history to East Central University. I make this authorization in return for ECU’s consideration for me for employment.
I release from liability all persons, companies and schools supplying such information. I indemnify East Central
University against any liability, which may result from making such requests. If I am employed, this release shall remain
in effect for the length of my employment. A copy of this form will serve as authorization to release information
I believe, to the best of my knowledge, that all information I have provided is accurate, true and correct, and that I fully
understand the terms of this release.
I agree that a copy or fax of this document shall be as valid as the original.
Name (please print):
Other names used (please print):
*Signature of Applicant: Date:
*This form is incomplete if it is not signed. Any and all incomplete application materials can cause a delay in the
application process. Return this form and all required application materials to the Employment Services Office, via
email (i.e., a scanned copy) to email@example.com, via fax (580)559-5484 (Attn: Ty Anderson, Director), or via ECU’s
mailing address at 1100 E. 14
St., Ada, OK, 74820.
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