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Initials:", "marker": "1.", "children": [ { "id": "p2.3.1.1", "order": 5, "type": "form_field", "bbox": { "l": 233.019, "t": 638.181, "r": 336.546, "b": 616.181 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial2_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.1", "text_offset": 307, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 0 }, { "id": "p2.3.2", "order": 6, "type": "list_item", "bbox": { "l": 50.64, "t": 610.08, "r": 575.04, "b": 553.44 }, "text": "Background Screening: I understand and consent to the University conducting all screenings required for my volunteer assignment, including a criminal background check, sex-offender registry check, and motor vehicle records check when applicable. I agree to complete all required authorization forms before beginning volunteer service. Initials:", "marker": "2.", "children": [ { "id": "p2.3.2.1", "order": 7, "type": "form_field", "bbox": { "l": 263.783, "t": 571.417, "r": 413.783, "b": 549.417 }, "text": "", "attrs": { "field_kind": "text", "label": "beginning volunteer service. Initials:", "pdf_field_name": "Initial3_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.2", "text_offset": 344, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 1 }, { "id": "p2.3.3", "order": 8, "type": "list_item", "bbox": { "l": 50.88, "t": 540.96, "r": 577.44, "b": 498.24 }, "text": "Uncompensated Volunteer Status: I understand that I am providing services voluntarily and without any promise, expectation, or receipt of wages, salary, benefits, or other compensation. I understand that I am not an employee of Kentucky State University because of my volunteer service. Initials:", "marker": "3.", "children": [ { "id": "p2.3.3.1", "order": 9, "type": "form_field", "bbox": { "l": 528.764, "t": 514.471, "r": 590.4, "b": 492.471 }, "text": "", "attrs": { "field_kind": "text", "label": "am not an employee of Kentucky State University because of my volunteer service. Initials:", "pdf_field_name": "Initial4_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.3", "text_offset": 296, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p2.3.4", "order": 10, "type": "list_item", "bbox": { "l": 51.84, "t": 485.52, "r": 579.84, "b": 443.04 }, "text": "No Employment Authority: I understand that I do not have the authority to enter into agreements, make financial commitments, hire or supervise employees, represent myself as a University employee, or otherwise bind the University unless specifically authorized in writing. Initials:", "marker": "4.", "children": [ { "id": "p2.3.4.1", "order": 11, "type": "form_field", "bbox": { "l": 496.691, "t": 459.489, "r": 583.854, "b": 437.489 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial5_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.4", "text_offset": 282, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 3 }, { "id": "p2.3.5", "order": 12, "type": "list_item", "bbox": { "l": 51.12, "t": 430.8, "r": 577.68, "b": 304.56 }, "text": "No Employee Benefits: I understand that my volunteer status does not entitle me to wages, stipends, health or life insurance, retirement benefits, paid leave, unemployment benefits, tuition assistance, relocation assistance, temporary or permanent housing, meal allowances, transportation benefits, travel reimbursement, or any other compensation or benefit provided to University employees. I also understand that I will not be issued University-owned vehicles, purchasing cards, credit cards, laptops, desktop computers, tablets, cellular phones, mobile devices, or similar equipment. Any limited access to University property, facilities, systems, or equipment must be approved in writing and does not create an employment relationship or entitlement to continued use. Any coverage for accidents, injuries, liability, or workers' compensation is subject to applicable law and University policy. Initials:", "marker": "5.", "children": [ { "id": "p2.3.5.1", "order": 13, "type": "form_field", "bbox": { "l": 511.746, "t": 320.725, "r": 586.473, "b": 298.725 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial6_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.5", "text_offset": 907, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 4 }, { "id": "p2.3.6", "order": 14, "type": "list_item", "bbox": { "l": 51.84, "t": 292.32, "r": 580.8, "b": 235.92 }, "text": "Campus Closure: I understand that I may not perform volunteer activities or be present on campus during University closures, including holidays, emergency closures, or weather-related closures. I also understand that I may not be on campus or perform volunteer activities without my designated supervisor present. Initials:", "marker": "6.", "children": [ { "id": "p2.3.6.1", "order": 15, "type": "form_field", "bbox": { "l": 173.455, "t": 251.343, "r": 323.455, "b": 229.343 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial7_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.6", "text_offset": 323, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 5 }, { "id": "p2.3.7", "order": 16, "type": "list_item", "bbox": { "l": 51.84, "t": 223.68, "r": 579.84, "b": 180.48 }, "text": "Compliance with University Requirements: I agree to follow all applicable University policies, procedures, safety requirements, instructions, and standards of conduct. I understand that I may not begin volunteer activities until all required approvals, screenings, and training have been completed. Initials:", "marker": "7.", "children": [ { "id": "p2.3.7.1", "order": 17, "type": "form_field", "bbox": { "l": 571.31, "t": 197.67, "r": 600.218, "b": 175.016 }, "text": "", "attrs": { "field_kind": "text", "label": "volunteer activities until all required approvals, screenings, and training have been completed. Initials:", "pdf_field_name": "Initial8_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.7", "text_offset": 308, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 6 }, { "id": "p2.3.8", "order": 18, "type": "list_item", "bbox": { "l": 51.6, "t": 168.72, "r": 572.64, "b": 125.76 }, "text": "Safety and Reporting Responsibilities: I agree to immediately report suspected abuse, discrimination, harassment, sexual misconduct, threats, unsafe conditions, injuries, or violations of law or University policy through the appropriate University reporting process. Initials:", "marker": "8.", "children": [ { "id": "p2.3.8.1", "order": 19, "type": "form_field", "bbox": { "l": 439.202, "t": 142.688, "r": 589.202, "b": 120.688 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial9_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.3.8", "text_offset": 276, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 7 } ], "reading_order": 2 } ] }, { "document_id": 15544, "page": 3, "width": 612, "height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 15655, "item_count": 22, "counts_by_type": { "form_field": 10, "heading": 1, "list": 1, "list_item": 7, "text": 3 }, "build_ms": 3, "items": [ { "id": "p3.1", "order": 1, "type": "list", "bbox": { "l": 51.6, "t": 741.36, "r": 575.76, "b": 299.28 }, "text": "", "attrs": { "item_count": 7 }, "children": [ { "id": "p3.1.1", "order": 2, "type": "list_item", "bbox": { "l": 51.84, "t": 741.36, "r": 575.76, "b": 684.96 }, "text": "Confidentiality: I agree to protect all confidential information obtained through my volunteer service, including student, employee, medical, financial, research, and educational records. I will not access, use, copy, discuss, or disclose confidential information unless authorized and necessary to perform my assigned duties. This obligation continues after my volunteer service ends. Initials:", "marker": "9.", "children": [ { "id": "p3.1.1.1", "order": 3, "type": "form_field", "bbox": { "l": 475.746, "t": 701.672, "r": 579.927, "b": 679.672 }, "text": "", "attrs": { "field_kind": "text", "label": "assigned duties. This obligation continues after my volunteer service ends. Initials:", "pdf_field_name": "Initial10_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.1.1", "text_offset": 395, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 0 }, { "id": "p3.1.2", "order": 4, "type": "list_item", "bbox": { "l": 52.8, "t": 672.48, "r": 574.32, "b": 643.92 }, "text": "University Property and Systems: I agree to use University facilities, equipment, technology, systems, records, identification credentials, and other property only as authorized. Initials:", "marker": "10.", "children": [ { "id": "p3.1.2.1", "order": 5, "type": "form_field", "bbox": { "l": 475.746, "t": 657.818, "r": 571.418, "b": 635.818 }, "text": "", "attrs": { "field_kind": "text", "label": "records, identification credentials, and other property only as authorized. Initials:", "pdf_field_name": "Initial11_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.1.2", "text_offset": 188, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 1 }, { "id": "p3.1.3", "order": 6, "type": "list_item", "bbox": { "l": 53.04, "t": 631.2, "r": 555.36, "b": 588.24 }, "text": "Transportation: I understand that I may not drive a University vehicle or use a personal vehicle for authorized University business unless I have received prior approval and completed all applicable driving and motor vehicle record requirements. Initials:", "marker": "11.", "children": [ { "id": "p3.1.3.1", "order": 7, "type": "form_field", "bbox": { "l": 373.747, "t": 607.417, "r": 523.747, "b": 585.417 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial12_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.1.3", "text_offset": 255, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p3.1.4", "order": 8, "type": "list_item", "bbox": { "l": 53.28, "t": 576, "r": 572.16, "b": 520.8 }, "text": "Termination of Volunteer Service: I understand that Kentucky State University may modify, suspend, or end my volunteer service at any time, with or without advance notice. I may also end my volunteer service at any time by notifying my University supervisor and Office of Human Resources.\nInitials:", "marker": "12.", "children": [ { "id": "p3.1.4.1", "order": 9, "type": "form_field", "bbox": { "l": 116.51, "t": 535.417, "r": 266.51, "b": 513.417 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial13_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.1.4", "text_offset": 298, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 3 }, { "id": "p3.1.5", "order": 10, "type": "list_item", "bbox": { "l": 52.56, "t": 507.12, "r": 565.44, "b": 450.96 }, "text": "Assumption of Risk: I understand that volunteer activities may involve risks, including bodily injury, illness, property damage, disability, or death. I knowingly accept and assume the risks reasonably associated with my authorized volunteer activities, including approved transportation connected with those activities. Initials:", "marker": "13.", "children": [ { "id": "p3.1.5.1", "order": 11, "type": "form_field", "bbox": { "l": 228.437, "t": 466.035, "r": 378.437, "b": 444.035 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial14_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.1.5", "text_offset": 330, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 4 }, { "id": "p3.1.6", "order": 12, "type": "list_item", "bbox": { "l": 52.32, "t": 438, "r": 531.12, "b": 368.64 }, "text": "Release of Claims: To the fullest extent permitted by law, I, on behalf of myself and my heirs, representatives, and assigns, release Kentucky State University, its Board of Regents, officers, employees, agents, and representatives from claims arising from my participation in authorized volunteer activities, except to the extent that a claim cannot legally be waived or released.\n\nInitials:", "marker": "14.", "children": [ { "id": "p3.1.6.1", "order": 13, "type": "form_field", "bbox": { "l": 118.473, "t": 382.907, "r": 268.473, "b": 360.907 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial15_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.1.6", "text_offset": 392, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 5 }, { "id": "p3.1.7", "order": 14, "type": "list_item", "bbox": { "l": 51.6, "t": 355.44, "r": 564.48, "b": 299.28 }, "text": "Entire Agreement: I acknowledge that I have read and understand this agreement and am signing it voluntarily. I understand that this agreement does not create an employment contract or guarantee any specific period of volunteer service. Any modification must be approved in writing by an authorized University representative. Initials:", "marker": "15.", "children": [ { "id": "p3.1.7.1", "order": 15, "type": "form_field", "bbox": { "l": 261.819, "t": 310.907, "r": 411.819, "b": 288.907 }, "text": "", "attrs": { "field_kind": "text", "label": "Initials:", "pdf_field_name": "Initial16_es_:signer:initials", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.1.7", "text_offset": 335, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 6 } ], "reading_order": 0 }, { "id": "p3.2", "order": 16, "type": "heading", "bbox": { "l": 36, "t": 284.16, "r": 262.56, "b": 268.8 }, "text": "SECTION IV: VOLUNTEER CERTIFICATION", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p3.3", "order": 17, "type": "text", "bbox": { "l": 33.6, "t": 250.8, "r": 567.6, "b": 221.28 }, "text": "By signing below, I certify that the information provided is accurate and that I accept the terms and conditions of this agreement.", "reading_order": 2 }, { "id": "p3.4", "order": 18, "type": "text", "bbox": { "l": 33.84, "t": 212.16, "r": 571.92, "b": 198.24 }, "text": "Printed Name: ___", "children": [ { "id": "p3.4.1", "order": 19, "type": "form_field", "bbox": { "l": 114.6, "t": 222.72, "r": 570.6, "b": 200.88 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Printed Name", "source": "acroform", "label": "Printed Name: ___", "label_source": "parent_text", "label_ref": "p3.4", "text_offset": 14, "text_span": 3 }, "reading_order": 0 } ], "reading_order": 3 }, { "id": "p3.5", "order": 20, "type": "text", "bbox": { "l": 35.04, "t": 177.12, "r": 573.36, "b": 162.48 }, "text": "Signature: ___ Date: ___", "children": [ { "id": "p3.5.1", "order": 21, "type": "form_field", "bbox": { "l": 456.84, "t": 187.2, "r": 570.96, "b": 165.36 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Date", "source": "acroform", "label": "Signature: ___ Date: ___", "label_source": "parent_text", "label_ref": "p3.5", "text_offset": 21, "text_span": 3 }, "reading_order": 0 }, { "id": "p3.5.2", "order": 22, "type": "form_field", "bbox": { "l": 97.5277, "t": 187.197, "r": 247.528, "b": 165.197 }, "text": "", "attrs": { "field_kind": "text", "label": "Signature:", "pdf_field_name": "Signature17_es_:signer:signature", "source": "acroform", "label_source": "parent_text", "label_ref": "p3.5", "text_offset": 11, "text_span": 3 }, "reading_order": 1 } ], "reading_order": 4 } ] } ] }