Personal History Statement (Phs) Page 14
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24Akron Police Division
Personal History Statement (PHS)
35. Have you ever had any merchandise you’ve purchased, repossessed?
Yes
No
If “Yes”, please give details (include when, firms involved, circumstances).
(Continue this response on a separate page if necessary)
Date:
Reasons:
Legal
36. Have you ever been charged, arrested or convicted for any criminal offense (including misdemeanor citations)? (Do not include
traffic tickets unless you were taken into custody).
Yes
No
If “Yes”, provide the following information, starting with the
most recent event. Explain in more detail on the back of the page
Date
Charge(s)
Police Agency/City or Locality
Penalty
37. Have you ever been placed on court probation as an adult?
Yes
No
Are you currently on probation:
Yes
No
If “Yes” to either, please give details (include when, where, why). Give dates of probation starting with the most recent.
38. Have you ever been detained, questioned, held on suspicion or fingerprinted, although not arrested, during the course of a criminal
investigation conducted by a law enforcement agency?
Yes
No
If “Yes”, explain in detail on a separate page.
39. Have you ever collected unemployment or welfare benefits (including food stamps) when you were not entitled to them, or received an
“overpayment” which you were required to repay?
Yes
No
If “Yes”, explain in detail on a separate page.
40. Have you complied with the draft registration laws?
Yes
No
If “No”, please explain in detail on a separate page.
41. Were you ever required to appear before a juvenile court for an act which would have been a crime if committed by an adult?
Yes
No
If “Yes”, please explain below and include dates.
(Continue this response on a separate page if necessary)
42. Have you ever been reported to a law enforcement agency as a missing person or a runaway?
Yes
No
If “Yes”, please give details including date, law enforcement agency and circumstances.
(Continue this response on a separate page if necessary)
43. Have you ever applied for a permit to carry a concealed weapon?
Yes
No
If “Yes”, please provide the following information:
Permit granted?
Date:
Name of law enforcement agency
Yes
No
44. Are you now or have you ever been involved as a plaintiff or defendant in any civil court action?
Yes
No
If “Yes”, please explain in detail, include when, where, name and location of court, circumstances, and outcome.
Page 14 of 24
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