Personal History Statement (Phs) Page 18
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24Akron Police Division
Personal History Statement (PHS)
Law Enforcement Information
63. Have you ever been a successful or unsuccessful candidate for any safety forces agency, including this department?
Yes
No
If “Yes”, list ALL agencies with which you have applied. Start with the most recent. Give complete, accurate
addresses. (All agencies MUST be listed regardless of outcome or current status. Check all boxes that apply for each agency.)
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
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
Page 18 of 24
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