Personal History Statement (Phs) Page 3
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24Akron Police Division
Personal History Statement (PHS)
List all children and other minors you are legally responsible for, including those which you have guardianship or legal custody. Minors will not be contacted.
Telephone number at which
Address where person can be contacted
person can be contacted
Name
Relationship
(Include City, State and Zip code)
(include area code)
(
)
Home
(
)
Cell
Home
(
)
Home
(
)
Cell
Home
(
)
Home
(
)
Cell
Home
(
)
Home
(
)
Cell
Home
(
)
Home
(
)
Cell
Home
References, Acquaintances
11. Please list those individuals with whom you have resided during the last 20 years, (i.e. roommates, friends, etc). Exclude your
spouse, children, or parents. Start with most recent. Provide us with their most current address. If current address is unknown,
indicate “unknown”. Do not include Military personnel if you lived on a military base.
Telephone number at which
Address where person can be contacted
person can be contacted
Name
(Include City, State and Zip code)
(include area code)
(
)
Home
(
)
Date: From:
To:
Cell
Home
(
)
Home
(
)
Date: From
To:
Cell
Home
(
)
Home
(
)
Date: From
To:
Cell
Home
(
)
Home
(
)
Date: From
To:
Cell
Home
(
)
Home
(
)
Date: From
To:
Cell
Home
(
)
Home
(
)
Date: From
To:
Cell
Home
(
)
Home
(
)
Cell
Date: From
To:
Home
Page 3 of 24
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal