{ "document_id": 15546, "page": 1, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 15656, "item_count": 36, "counts_by_type": { "figure": 2, "form_field": 18, "header": 1, "heading": 3, "text": 12 }, "build_ms": 3, "items": [ { "id": "p1.1", "order": 1, "type": "figure", "bbox": { "l": 58.56, "t": 781.92, "r": 152.64, "b": 701.76 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" } }, { "id": "p1.2", "order": 2, "type": "header", "bbox": { "l": 355.92, "t": 749.04, "r": 565.92, "b": 701.04 }, "text": "OFFICE OF HUMAN RESOURCES\nACADEMIC SERVICES #241 | 400 EAST MAIN STREET\nFRANKFORT, KY 40601 | (502) 597-6667\nKYSU.EDU", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p1.3", "order": 3, "type": "figure", "bbox": { "l": 43.5, "t": 782.4499, "r": 567.95, "b": 702.2 }, "text": "", "attrs": { "source": "pdf_image" } }, { "id": "p1.4", "order": 4, "type": "heading", "bbox": { "l": 126, "t": 687.12, "r": 485.04, "b": 670.8 }, "text": "BACKGROUND CHECK INFORMATION FORM", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p1.5", "order": 5, "type": "text", "bbox": { "l": 33.36, "t": 655.68, "r": 577.92, "b": 598.32 }, "text": "Kentucky State University (KSU) conducts background checks on employees, volunteers, and other individuals as required by law and University policy. The information you provide below will be used solely for the purpose of obtaining background check reports in accordance with the Fair Credit Reporting Act (FCRA) and applicable state and federal regulations." }, { "id": "p1.6", "order": 6, "type": "text", "bbox": { "l": 33.84, "t": 586.8, "r": 377.28, "b": 571.44 }, "text": "Completion of this form is required to process your background check." }, { "id": "p1.7", "order": 7, "type": "heading", "bbox": { "l": 34.56, "t": 558.96, "r": 152.64, "b": 544.56 }, "text": "Personal Information:", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p1.8", "order": 8, "type": "form_field", "bbox": { "l": 38.6725, "t": 537.131, "r": 210.872, "b": 519.109 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "First Name", "source": "acroform" } }, { "id": "p1.9", "order": 9, "type": "form_field", "bbox": { "l": 223.058, "t": 536.476, "r": 404.258, "b": 517.8 }, "text": "", "attrs": { "field_kind": "text", 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"", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_2", "source": "acroform", "label": "Date of Birth: ___ / ___ / ___ Social Security Number: ___ / ___ / ___", "label_source": "parent_text", "label_ref": "p1.15", "text_offset": 21, "text_span": 3 } }, { "id": "p1.15.3", "order": 19, "type": "form_field", "bbox": { "l": 522.72, "t": 427.636, "r": 570.72, "b": 408 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_4", "source": "acroform", "label": "Date of Birth: ___ / ___ / ___ Social Security Number: ___ / ___ / ___", "label_source": "parent_text", "label_ref": "p1.15", "text_offset": 67, "text_span": 3 } }, { "id": "p1.15.4", "order": 20, "type": "form_field", "bbox": { "l": 110.16, "t": 426.982, "r": 158.16, "b": 408 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Date of Birth", "source": "acroform", "label": "Date of Birth: ___ / ___ / ___ Social Security Number: ___ / ___ / ___", "label_source": "parent_text", 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"b": 300.96 }, "text": "City _____ State _____ Zip: _____", "children": [ { "id": "p1.18.1", "order": 28, "type": "form_field", "bbox": { "l": 60.96, "t": 332.76, "r": 234.96, "b": 303.96 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "City", "source": "acroform", "label": "City _____ State _____ Zip: _____", "label_source": "parent_text", "label_ref": "p1.18", "text_offset": 5, "text_span": 5 } }, { "id": "p1.18.2", "order": 29, "type": "form_field", "bbox": { "l": 266.88, "t": 332.76, "r": 423, "b": 303.96 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "State", "source": "acroform", "label": "City _____ State _____ Zip: _____", "label_source": "parent_text", "label_ref": "p1.18", "text_offset": 17, "text_span": 5 } }, { "id": "p1.18.3", "order": 30, "type": "form_field", "bbox": { "l": 451.08, "t": 332.76, "r": 570.96, "b": 303.96 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Zip", "source": "acroform", "label": "City _____ State _____ Zip: _____", "label_source": "parent_text", "label_ref": "p1.18", "text_offset": 28, "text_span": 5 } } ] }, { "id": "p1.19", "order": 31, "type": "text", "bbox": { "l": 35.04, "t": 282, "r": 571.68, "b": 266.4 }, "text": "Phone Number: ___ Email Address: ___", "children": [ { "id": "p1.19.1", "order": 32, "type": "form_field", "bbox": { "l": 120.6, "t": 298.08, "r": 306.72, "b": 269.28 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Phone Number", "source": "acroform", "label": "Phone Number: ___ Email Address: ___", "label_source": "parent_text", "label_ref": "p1.19", "text_offset": 14, "text_span": 3 } }, { "id": "p1.19.2", "order": 33, "type": "form_field", "bbox": { "l": 392.4, "t": 298.08, "r": 572.4, "b": 269.28 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Email Address", "source": "acroform", "label": "Phone Number: ___ Email Address: ___", "label_source": "parent_text", "label_ref": "p1.19", "text_offset": 33, "text_span": 3 } } ] }, { "id": "p1.20", "order": 34, "type": "heading", "bbox": { "l": 33.6, "t": 246.24, "r": 160.56, "b": 232.08 }, "text": "State Law Requirement", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p1.21", "order": 35, "type": "text", "bbox": { "l": 33.84, "t": 217.92, "r": 552, "b": 173.76 }, "text": "□ I understand that state law requires both a state and national criminal history and background check as a condition of employment. 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