Police Department Personal History Statement Form Page 12
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2225j.
List any military personnel who would be familiar with your performance and provide a telephone number where they may be
contacted: ___________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
25k. Are you still participating in any Military Reserve or National Guard Unit?
Yes
No Unit ___________________
If yes, indicate your supervisor and phone number ___________________________________________________________
25l.
List any awards or decorations you received while in the military: ______________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
25m. List any illegal drugs used or possessed while in the military: __________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
FINANCIAL
Your responsibility in incurring and meeting your financial obligations reflects upon your dependability and good judgment.
26.
Have your wages ever been garnished?
Yes
No
If yes, please explain __________________________________________________________________________________
27.
Have any of your bills been turned over for collection?
Yes
No
If yes, why, and has that debt been satisfied? _______________________________________________________________
28.
Have any goods you purchased been repossessed?
Yes
No
If yes, please explain __________________________________________________________________________________
29.
Have you ever been delinquent on income or other tax payments?
Yes
No
If yes, please explain __________________________________________________________________________________
30.
Have you ever filed for bankruptcy?
Yes
No
If yes, please explain __________________________________________________________________________________
Location of Bankruptcy Court in which your petition was filed: ________________________________________________
Has the bankruptcy been fully discharged?
Yes
No
Date: ____________________________________________
What was the amount of debt that was discharged? __________________________________________________________
31.
Have you ever been or are you now delinquent on any court ordered payment(s)? (i.e., child support, alimony, etc.),
Yes
No
If yes, please explain ___________________________________________________________________
32.
Please list any other financial situations or circumstances that you feel might need to be explained.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
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