Personal History Statement (Phs) Page 4
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24Akron Police Division
Personal History Statement (PHS)
12. Please list as references five (5) individuals you have known for at least two (2) years who have knowledge of you and your
qualifications. Examples include personal friends, fiancée, boyfriends, girlfriends, friends of the family, roommates, teachers,
neighbors, classmates, co-workers, past supervisors or acquaintances. DO NOT include relatives or family members.
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
(
)
How Known?
How Long?:
Cell
Home
(
)
Home
(
)
How Known?
How Long?:
Cell
Home
(
)
Home
(
)
How Known?
How Long?:
Cell
Home
(
)
Home
(
)
How Known?
How Long?:
Cell
Home
(
)
Home
(
)
How Known?
How Long?:
Cell
Home
(
)
Home
(
)
How Known?
How Long?:
Cell
Home
13. Please list any individuals that you are acquainted with who are members of safety forces. Exclude individuals who are listed in
question #11 and #12.
Telephone number at which
Address where person can be contacted
person can be contacted
Name and Rank:
(Include City, State and Zip code)
(include area code)
(
)
Home
(
)
Department:
Cell
Home
(
)
Home
(
)
Department:
Cell
Home
(
)
Home
(
)
Department:
Cell
Home
(
)
Home
(
)
Department:
Cell
Home
(
)
Home
(
)
Department:
Cell
Home
(
)
Home
(
)
Department:
Cell
Home
Page 4 of 24
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