Personal History Statement (Phs) Page 21
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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
64. Do you have any prior police experience? (Including police reserves.)
Yes
No.
Agency
Rank, Title, Position
Date
65. Have you ever attended any law enforcement training academy?
Yes
No
Academy Name:
Dates:
Did you complete the training?
to
from
Yes
No
Address:
City:
State:
Zip Code:
Academy Name:
Dates:
Did you complete the training?
to
from
Yes
No
Address:
City:
State:
Zip Code:
Academy Name:
Dates:
Did you complete the training?
to
from
Yes
No
Address:
City:
State:
Zip Code:
Page 21 of 24
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