Personal History Statement (Phs) Page 10
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24Akron Police Division
Personal History Statement (PHS)
19. Have you ever been investigated by any employer or supervisor for improper conduct or illegal activities which resulted in your being
found in violation of any policies, regulations, rules, or any State or Federal laws?
Yes
No
If “Yes”, please provide the following information.
Date:
Employer:
Details and results of investigation
(Continue this response on a separate page if necessary)
.
Would any problem result if your present employer was contacted during the course of the background investigation?
Yes
No
If “Yes”, please explain below.
(Continue this response on a separate page if necessary)
20. Have you ever held employment under another name? Including maiden name, nickname or aliases.
Yes
No
If “Yes”, please give details (include when, employer(s)).
(Continue this response on a separate page if necessary)
Name Used:
Employer:
Dates:
Name Used:
Employer:
Dates:
Name Used:
Employer:
Dates:
Name Used:
Employer:
Dates:
21. Have you had any extended work absences for reasons other than earned vacation, suspension, lay-offs, or other non-medical leave
Yes
No If “Yes”, please explain (include when, employer(s) and why).
(Continue this response on a separate page if necessary)
Date:
Employer:
Details:
Date:
Employer:
Details:
22. Have you ever been fired, suspended, asked to resign, disciplined or received a formal reprimand from any place of employment?
Yes
No
If “Yes”, please give details (include when, employer(s), why).
(Continue this response on a separate page if necessary)
Date:
Employer:
Details:
Date:
Employer:
Details:
23. If you have never held employment, please explain why.
(Continue this response on a separate page if necessary)
Page 10 of 24
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