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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Joint Appointments - Research                   "]
[]
[]
["Employee ID:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SSN:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Beginning Date:",null,null,null,null,null,null,null,null,null,null,null,null,"Ending Date:"]
[]
["Name: (Name on your current Social Security Card)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Birth Date (mm/dd/yyyy):",null,null,null,null,null,null,null,null,null,null,null,"Home Phone: \n\n",null,null,null,null,null,null,null,null,null,null,"Sex:"]
[]
["Street/P.O. Box:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"City: ",null,null,null,null,null,null,null,null,null,null,null,"State:",null,null,null,null,null,null,null,null,"Zip Code:"]
[]
["Citizenship ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Non-Resident Aliens Only",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Military Status"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Citizenship Country",null,null,null,null,null,null,null,null,null,null,null,null,"Visa Type"]
[]
[]
["Highest Educational Level",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ethnic"]
[]
[]
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[]
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["The University relies on the goodwill and support of its volunteer service providers in a variety of areas.  I understand that this appointment enhances the academic strengths of the University and will conduct activities (herein defined as Project) according to the terms of my joint appointment. The Project is generally defined below and may occur on or off the premises of Northern Illinois University.  "]
["[Put description of appointment activities here, including sponsored project information if serving as a Principal Investigator."]
["In the event of an injury during or related to the Project conducted for Northern Illinois University as part of this appointment,"]
["I,",{"$f":"$A$7","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," (please print name), understand and accept the general and specific"]
["personal risks of injury or other loss involved with this Project and that University coverage shall be consistent with the terms of my appointment.  In consideration of Northern Illinois University’s permitting me to participate in this Project, I agree subject only to limitations of acts of gross negligence by the University, that neither I, nor my agent, family, heirs or personal representative will hold the State of Illinois, Northern Illinois University, its Board of Trustees or any of its employees or agents legally or financially responsible for any injury, losses, damages or expenses incurred from any injury I may experience that may be directly or indirectly attributed to the above-named Project.  I agree to obtain and maintain my own personal health insurance for personal injuries or sickness."]
[]
["I agree to abide with all Safety Rules and other University policies and procedures applicable to the activities as part of this Project.  I attest and certify that I am physically fit and retain the necessary skill and expertise to conduct this Project.  Based on these representations on which all representatives of Northern Illinois University may legally and morally rely without qualification, I request permission to participate in this Project and will work with the University to obtain any additional approvals that may be required.   "]
[]
["I understand my work in this role will be subject to the same standards of oversight and performance that are applicable to regular employees.  Accordingly, I will have access to college facilities and resources as provided and coordinated by department and college administrators.  It is understood my services under this Agreement will also be considered covered under the State Employee Indemnification Act, though not by the State’s workers compensation program.  My signature below confirms my acceptance of these terms and conditions.  "]
["I understand that my participation on this project may be subject to background check, as determined by Human Resource Services and the department overseeing the volunteer."]
[]
["Offered by:                                                                                  Accepted by:\n\n_________________________________ ______________        _________________________________ ______________  ___________\nDean                                                           Date                           Joint Appointee           Department           Date\n\nNIU Office of Legal Services/1-03"]
["For Departmental Use Only:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"For HRS Use Only:"]
["Please indicate which of the following are applicable to this position:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BC",null,null,null,null,null,null,"Y / N"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"IT",null,null,null,null,null,null,"Y / N"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MR",null,null,null,null,null,null,"Y / N"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PI",null,null,null,null,null,null,"Y / N"]
[]
["The social security number is required for the furtherance of operations and business of the University which includes but is not limited to the provision of proper security access. \n"]

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["For Departmental Use Only:"]
["Please indicate which of the following are applicable to this position:"]