Personal History Statement (Phs) Page 7
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24Akron Police Division
Personal History Statement (PHS)
Dates
If rented, give name, address and telephone of the
Address
City, State, Zip Code
Person responsible for the collection of the rent
From
To
Mo / Yr
Mo/Yr
J
With whom did you live? (include relationship)
Reason for moving
K
With whom did you live? (include relationship)
Reason for moving
L
With whom did you live? (include relationship)
Reason for moving
Experience and Employment
18. Beginning with your most current employment, please list every job you have held in the last 20 years. All time periods must be
accounted for. Jobs include self-employment, part-time jobs, temporary work, volunteer work and internships. You must list all
employment regardless of the length of employment. Addresses must be complete, current and accurate. Zip codes are required. If
you have had intervening periods of unemployment, please list those periods in sequence in the spaces specifically provided. Start
with your most current employment.
Dates of employment
Name and complete address of employer, include zip code
Name and Title of Supervisor
Telephone No.
From
To
Mo. Yr.
Mo. Yr.
/
/
Job title and duties (for identification purposes)
Present
Co-Workers
Full-Time
Name:
Yrs.
Part-time
Ph. No.:
Voluntary
Name:
Mo.
Ph. No.:
Reason for leaving.
Mo.
Yr.
Mo.
Yr.
Not employed
From
/
To
/
Dates of employment
Name and complete address of employer, include zip code
Name and Title of Supervisor
Telephone No.
From
To
Mo. Yr.
Mo. Yr.
/
/
Job title and duties (for identification purposes)
Present
Co-Workers
Full-Time
Name:
Yrs.
Part-time
Ph. No.:
Voluntary
Name:
Mo.
Ph. No.:
Reason for leaving.
Mo.
Yr.
Mo.
Yr.
Not employed
From
/
To
/
Page 7 of 24
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