Personal History Statement (Phs) Page 20
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24Akron Police Division
Personal History Statement (PHS)
Name of Agency – Complete Address, Zip code, Telephone
Position/Classification
Date (Month/Year)
Submitted Application Only
STATUS AND/OR RESULTS:
Took Written Exam?
Yes
No
Took Physical Fitness or Agility Test?
Yes
No
Submitted Background Packet?
Yes
No
Background Investigation Conducted?
Yes
No
Unknown
Disqualified?
Yes
No
Polygraph?
Yes
No
Withdrew Application?
Yes
No
Name of Agency – Complete Address, Zip code, Telephone
Position/Classification
Date (Month/Year)
Submitted Application Only
STATUS AND/OR RESULTS:
Took Written Exam?
Yes
No
Took Physical Fitness or Agility Test?
Yes
No
Submitted Background Packet?
Yes
No
Background Investigation Conducted?
Yes
No
Unknown
Disqualified?
Yes
No
Polygraph?
Yes
No
Withdrew Application?
Yes
No
Name of Agency – Complete Address, Zip code, Telephone
Position/Classification
Date (Month/Year)
Submitted Application Only
STATUS AND/OR RESULTS:
Took Written Exam?
Yes
No
Took Physical Fitness or Agility Test?
Yes
No
Submitted Background Packet?
Yes
No
Background Investigation Conducted?
Yes
No
Unknown
Disqualified?
Yes
No
Polygraph?
Yes
No
Withdrew Application?
Yes
No
Name of Agency – Complete Address, Zip code, Telephone
Position/Classification
Date (Month/Year)
Submitted Application Only
STATUS AND/OR RESULTS:
Took Written Exam?
Yes
No
Took Physical Fitness or Agility Test?
Yes
No
Submitted Background Packet?
Yes
No
Background Investigation Conducted?
Yes
No
Unknown
Disqualified?
Yes
No
Polygraph?
Yes
No
Withdrew Application?
Yes
No
Page 20 of 24
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