{ "document_id": 15886, "page": 5, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 15996, "item_count": 37, "counts_by_type": { "figure": 3, "footer": 1, "form_field": 4, "header": 2, "heading": 3, "table": 1, "table_cell": 14, "text": 9 }, "build_ms": 3, "items": [ { "id": "p5.1", "order": 1, "type": "header", "bbox": { "l": 14.88, "t": 782.64, "r": 263.52, "b": 772.08 }, "text": "DocuSign Envelope ID: 6579E845-974B-40CA-9C15-2984DEAE44DF", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p5.2", "order": 2, "type": "figure", "bbox": { "l": 38.64, "t": 770.16, "r": 108.72, "b": 703.2 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" } }, { "id": "p5.3", "order": 3, "type": "header", "bbox": { "l": 404.64, "t": 770.64, "r": 578.64, "b": 731.76 }, "text": "Background Check Information Form", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p5.4", "order": 4, "type": "table", "bbox": { "l": 36.96, "t": 692.88, "r": 576.48, "b": 439.92 }, "text": "", "attrs": { "block_label": "table", "n_rows": 5, "n_cols": 4, "integrity": { "cells_checked": 8, "cells_flagged": 1, "flags": [ { "row": 0, "col": 0, "coverage": 0.25, "text": "PART I: APPLICANT INFORMATION" } ] } }, "children": [ { "id": "p5.4.1", "order": 5, "type": "table_cell", "bbox": { "l": 36.96, "t": 692.88, "r": 576.48, "b": 671.8 }, "text": "PART I: APPLICANT INFORMATION", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 4 } }, { "id": "p5.4.2", "order": 6, "type": "table_cell", "bbox": { "l": 41.88, "t": 662.9424, "r": 148.864224, "b": 625.77072 }, "text": "Position Applied For:\nInterviewing Official:", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p5.4.3", "order": 7, "type": "table_cell", "bbox": { "l": 171.84, "t": 671.8, "r": 576.48, "b": 650.72 }, "text": "", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 3 } }, { "id": "p5.4.4", "order": 8, "type": "table_cell", "bbox": { "l": 41.88, "t": 610.0224000000001, "r": 117.296448, "b": 521.13072 }, "text": "First Name:\nMiddle Name:\nLast Name:\nAddress:\nCity/ST/Zip", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true, "column_header": true, "header_source": "pdf" } }, { "id": "p5.4.5", "order": 9, "type": "table_cell", "bbox": { "l": 171.84, "t": 629.64, "r": 306.72, "b": 608.56 }, "text": "", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p5.4.6", "order": 10, "type": "table_cell", "bbox": { "l": 440.4, "t": 610.0224000000001, "r": 542.33784, "b": 594.9307200000001 }, "text": "Other Names Used:", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p5.4.7", "order": 11, "type": "table_cell", "bbox": { "l": 41.88, "t": 517.7424, "r": 177.8928, "b": 465.57072 }, "text": "SSN:\nDriver's License:\nName on Driver's License:", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p5.4.8", "order": 12, "type": "table_cell", "bbox": { "l": 171.84, "t": 524.24, "r": 306.72, "b": 503.16 }, "text": "", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p5.4.9", "order": 13, "type": "table_cell", "bbox": { "l": 324.72, "t": 517.7424, "r": 392.589504, "b": 484.05072 }, "text": "Date of Birth:\nIssuing State:", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p5.4.10", "order": 14, "type": "table_cell", "bbox": { "l": 441.6, "t": 524.24, "r": 576.48, "b": 503.16 }, "text": "", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p5.4.11", "order": 15, "type": "table_cell", "bbox": { "l": 41.88, "t": 462.1824, "r": 144.423936, "b": 447.09072 }, "text": "Contact Phone No:", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p5.4.12", "order": 16, "type": "table_cell", "bbox": { "l": 171.84, "t": 461, "r": 306.72, "b": 439.92 }, "text": "", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p5.4.13", "order": 17, "type": "table_cell", "bbox": { "l": 324.72, "t": 462.1824, "r": 359.107392, "b": 447.09072 }, "text": "E-mail:", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p5.4.14", "order": 18, "type": "table_cell", "bbox": { "l": 441.6, "t": 461, "r": 576.48, "b": 439.92 }, "text": "", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p5.5", "order": 19, "type": "text", "bbox": { "l": 35.04, "t": 436.08, "r": 255.36, "b": 421.92 }, "text": "PART II: DISCLOSURE OF VIOLATIONS OR CONVICTIONS" }, { "id": "p5.6", "order": 20, "type": "text", "bbox": { "l": 34.08, "t": 412.32, "r": 574.32, "b": 373.2 }, "text": "I understand that state law requires a state and national criminal history and background check as a condition of employment. I further understand that a conviction reported below will not automatically disqualify me from employment." }, { "id": "p5.7", "order": 21, "type": "text", "bbox": { "l": 33.84, "t": 362.64, "r": 554.4, "b": 334.32 }, "text": "Have you ever been convicted for any violation(s) of law, including moving traffic violations? □ Yes □ No\nIf YES, please provide the following:", "children": [ { "id": "p5.7.1", "order": 22, "type": "form_field", "bbox": { "l": 504.82, "t": 362.64, "r": 516.82, "b": 350.64 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "Yes", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p5.7", "text_offset": 95, "text_span": 1 } }, { "id": "p5.7.2", "order": 23, "type": "form_field", "bbox": { "l": 534.57, "t": 362.64, "r": 546.57, "b": 350.64 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "No", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p5.7", "text_offset": 101, "text_span": 1 } } ] }, { "id": "p5.8", "order": 24, "type": "figure", "bbox": { "l": 33.6, "t": 331.2, "r": 575.28, "b": 249.12 }, "text": "", "attrs": { "block_label": "image" }, "children": [ { "id": "p5.8.1", "order": 25, "type": "heading", "bbox": { "l": 35.76, "t": 329.76, "r": 147.6, "b": 316.8 }, "text": "Description of Offense:", "level": 3 }, { "id": "p5.8.2", "order": 26, "type": "text", "bbox": { "l": 35.76, "t": 284.16, "r": 187.44, "b": 255.6 }, "text": "Statute or ordinance (if known):\nCounty/City/ST of conviction:" }, { "id": "p5.8.3", "order": 27, "type": "text", "bbox": { "l": 346.32, "t": 283.92, "r": 432.48, "b": 255.84 }, "text": "Date of Charge: Conviction Date:" } ] }, { "id": "p5.9", "order": 28, "type": "text", "bbox": { "l": 33.84, "t": 255.12, "r": 386.16, "b": 242.16 }, "text": "(For additional convictions use plain paper. Include all information listed above.)\nAnswer these questions for all positions requiring the use of a vehicle: Have your driving privileges ever been revoked or suspended? □ Yes □ No\nIf yes, list here:", "children": [ { "id": "p5.9.1", "order": 29, "type": "form_field", "bbox": { "l": 361.69, "t": 250.8, "r": 367.69, "b": 244.8 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "Yes", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p5.9", "text_offset": 218, "text_span": 1 } }, { "id": "p5.9.2", "order": 30, "type": "form_field", "bbox": { "l": 376.37, "t": 250.8, "r": 382.37, "b": 244.8 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "No", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p5.9", "text_offset": 224, "text_span": 1 } } ] }, { "id": "p5.10", "order": 31, "type": "heading", "bbox": { "l": 34.56, "t": 194.64, "r": 105.36, "b": 181.68 }, "text": "If yes, list here:", "level": 3 }, { "id": "p5.11", "order": 32, "type": "figure", "bbox": { "l": 36.96, "t": 190.8, "r": 574.56, "b": 119.28 }, "text": "", "attrs": { "block_label": "image", "embedded_text": "P ART III: A UTHORIZATION" } }, { "id": "p5.12", "order": 33, "type": "heading", "bbox": { "l": 35.76, "t": 131.04, "r": 141.12, "b": 117.6 }, "text": "PART III: AUTHORIZATION", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p5.13", "order": 34, "type": "text", "bbox": { "l": 33.84, "t": 107.04, "r": 567.84, "b": 80.88 }, "text": "The facts as stated on this form are true and correct. I understand that, if employed, false statements on this or any university form may cause my immediate dismissal." }, { "id": "p5.14", "order": 35, "type": "text", "bbox": { "l": 36, "t": 57.84, "r": 577.2, "b": 44.4 }, "text": "\\qquad\\qquad Date: _____" }, { "id": "p5.15", "order": 36, "type": "text", "bbox": { "l": 33.36, "t": 57.6, "r": 146.64, "b": 44.88 }, "text": "Signature of Applicant: ___" }, { "id": "p5.16", "order": 37, "type": "footer", "bbox": { "l": 484.8, "t": 26.16, "r": 589.44, "b": 17.28 }, "text": "Background Check Information 12 12 2018", "attrs": { "block_label": "footer" } } ], "excluded_furniture": { "first": [], "last": [] } }