Tallahassee police department personal history statement



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TALLAHASSEE POLICE DEPARTMENT

PERSONAL HISTORY STATEMENT



Please complete the Personal History Statement (PHS) and attach this document to your City of Tallahassee electronic application. The purpose of the PHS is to determine whether or not you meet the MINIMUM hiring standards of the Tallahassee Police Department (TPD).
The information you are required to provide in this document must be true, accurate, complete, and without omission of any kind. It is YOUR responsibility to do so, and you must realize that failure to do so, for any reason will result in your immediate suspension from the selection/hiring process.

An omission may be considered an untruthful answer. I understand and

agree. Click here to enter text. (Place applicant’s initials)
Once it is determined you meet the minimum standards for hire AND you pass the written examination process, you will be provided a Personal History and Truth Verification Packet (PHTVP). This packet will ask more detailed questions. The information in the PHS and the PHTVP should be consistent. Inconsistencies among common questions in both packets could prevent you from moving forward in our hiring process.

As always, thank you for your interest in working at the Tallahassee Police Department. If you have any questions regarding the hiring process, please call (850) 891-4324 and ask to speak with a Recruiter or contact us via e-mail at tpdapplicants@talgov.com. Additional information can also be received by visiting our website http://www.talgov.com/tpd



PERSONAL HISTORY STATEMENT
Police Officer/Trainee Application

Tallahassee Police Department


Date: Click here to enter a date.

I. Current Personal Data
A. Full Name: Click here to enter text., Click here to enter text., Click here to enter text.

(last) (first) (middle)


Address (No., Street, Apt., State, Zip): Click here to enter text.

Home Phone: Click here to enter text. Cell Phone: Click here to enter text.

Email Address: Click here to enter text.
Social Security Number: Click here to enter text. Date of Birth: Click here to enter a date.
B. Race: Click here to enter text. Gender: Click here to enter text.

Height: Click here to enter text. Eye Color: Click here to enter text.

Hair Color Click here to enter text.
C. Have you ever had your name changed? Yes ☐ No ☐

If yes: Previous Name (s): Click here to enter text.

Date of Change Click here to enter a date. Location of change: Click here to enter text.

Reason for change: Click here to enter text.


D. Have you ever previously applied to the Tallahassee Police Department? Yes ☐ No ☐

If yes, which position Click here to enter text. Date: Click here to enter a date.


II. Citizenship Data
A. Are you a U.S. Citizen? Yes ☐ No ☐
B. Did you obtain U.S. citizenship by naturalization? Yes ☐ No ☐ N/A ☐
C. N/A ☐, Naturalization Date: Click here to enter a date. Location: Click here to enter text.

Number: Click here to enter text.



III. Law Enforcement Education/Experience
A. N/A ☐ What is the name of the Law Enforcement Academy did you attended?

Click here to enter text.

Address (No., Street, Apt., City, State, Zip): Click here to enter text.

Class Coordinator: Click here to enter text. Phone No.: Click here to enter text.

Certification Received: Yes ☐ No ☐ , Certification # Click here to enter text.


B. If you have Law Enforcement experience, have you ever been or are currently under an internal investigations? Yes ☐ No ☐ N/A ☐

If yes, list the employer, and each incident, date, and outcome Click here to enter text.


C. N/A ☐ If not presently working as a Law Enforcement Officer, date last worked as a certified Law Enforcement Officer. Click here to enter a date. State Click here to enter text.
D. N/A ☐, How long have you been a “Full-time” Law Enforcement Officer (Full-time Military Police experience also counts.) Years Click here to enter text.

Months Click here to enter text.


E. Have you ever applied to another Law Enforcement Agency? Yes ☐ No ☐ N/A ☐

If yes, please list ALL agencies below.
1. Agency Name: Click here to enter text.

Address (No., Street, Apt., City, State, Zip): Click here to enter text.

Date Applied: Click here to enter a date.

Status of Application: Click here to enter text.


2. Agency Name: Click here to enter text.

Address (No., Street, Apt., City, State, Zip): Click here to enter text.

Date Applied: Click here to enter a date.

Status of Application: Click here to enter text.


3. Agency Name: Click here to enter text.

Address (No., Street, Apt., City, State, Zip): Click here to enter text.

Date Applied: Click here to enter a date.

Status of Application: Click here to enter text.





  • Attach additional sheets if necessary

F. If you have not attended a Law Enforcement Academy, are you requesting sponsorship?

Yes ☐ No ☐ N/A ☐
G. Have you completed the CJBAT? If yes, what was your score? Yes ☐ No ☐ N/A ☐

Score: Click here to enter text.


IV. Driving History
A. Have you ever had a driver’s license in any state other than the state of Florida?

Yes ☐ No ☐. If yes, give the state, driver’s license number and date of expiration and submit a 7-year driving history from each state.


State Driver’s License Number Date of Expiration

Click here to enter text. Click here to enter text. Click here to enter a date.

Click here to enter text. Click here to enter text. Click here to enter a date.

Click here to enter text. Click here to enter text. Click here to enter a date.

Click here to enter text. Click here to enter text. Click here to enter a date.
B. Have you ever been given a traffic citation and/or paid a fine for ANY traffic violation?

Yes ☐ No ☐


List ALL moving and non-moving traffic citations, (i.e. speeding, running a red light, expired registration, no insurance, etc.) that you have received in the past 10 years, starting with the most recent. (A report from the Department of Highway Safety might not give you all tickets you have received, that information can be purged out of their system, do not rely on that report.)
Date issued Type of violation Issuing Agency

Click here to enter a date. Click here to enter text. Click here to enter text.

Disposition



Click here to enter text.
Date issued Type of violation Issuing Agency

Click here to enter a date. Click here to enter text. Click here to enter text.

Disposition



Click here to enter text.
Date issued Type of violation Issuing Agency

Click here to enter a date. Click here to enter text. Click here to enter text.

Disposition



Click here to enter text.


  • Attach additional sheets if necessary

C. Has your driver’s license ever been suspended or revoked? Yes ☐ No ☐

If yes, for what reason(s)? Click here to enter text.

Length of suspension(s) Click here to enter text.

Date reinstated Click here to enter a date.

V. Military Experience
A. Have you ever been in the United States Armed Forces? Yes ☐ No ☐ N/A ☐

If yes, Branch of Service Click here to enter text.

Dates of Service Click here to enter a date. to Click here to enter a date.
B. While in the military, were you ever reprimanded, convicted or adjudicated guilty of any offense under the Uniform Code of Military Justice? Yes ☐ No ☐ N/A ☐

If yes, explain in detail: Click here to enter text.


C. Did you receive an honorable discharge from your military service?

Yes ☐ No ☐ N/A ☐

If no, what type of discharge did you receive? Click here to enter text.
A copy of your DD214 – Member 4 Copy (with characterization of discharge) for each tour of duty MUST be provided along with the other required documentation
C. If you are male between the ages of 18 and 26, have you registered for the draft?

Yes ☐ No ☐ N/A ☐


VI. Personal Character Background
A. Do you currently or have you ever use tobacco products? Yes ☐ No ☐
SPECIAL NOTE: If yes please know your will be required what to quit prior to hire.
B. With respect to illegal drugs, including but not limited to marijuana, hashish, speed, cocaine, heroin, ecstasy, mushrooms, PCP, LSD, steroids, crack, etc., and prescription drugs not prescribed to you or used in the manner in which they were prescribed:
Have you ever used, possessed or experimented with illegal drugs, including but not limited to those listed above? Yes ☐ No ☐
Have you ever purchased illegal drugs, including but not limited to those listed above? Yes ☐ No ☐
Have you ever sold (as defined in criminal statutes) illegal drugs, including but not limited to those listed above? Yes ☐ No ☐
If you answered “YES” to any of the above, list the type of drug, the frequency of use, sale, purchase and/or possession of each drug. Please list the month and year of the first and last time used, sold, purchased and/or possessed. If the frequency, month and year are not listed, your application will not be processed.
1. Drug Type: Click here to enter text.

Date of Use Click here to enter a date. - Click here to enter a date.

Frequency of Use: Click here to enter text.
2. Drug Type: Click here to enter text.

Date of Use Click here to enter a date. - Click here to enter a date.

Frequency of Use: Click here to enter text.
3. Drug Type: Click here to enter text.

Date of Use Click here to enter a date. - Click here to enter a date.

Frequency of Use: Click here to enter text.

4. Drug Type: Click here to enter text.

Date of Use Click here to enter a date. - Click here to enter a date.

Frequency of Use: Click here to enter text.




  • Attach additional sheets if necessary

C. When was the last time anyone used illegal drugs/illegal controlled substances in your presence, included but not limited to those listed above?

N/A ☐ Click here to enter a date.
What was the illegal drug and under what circumstances did you see the illegal drug used? N/A ☐ Click here to enter text.
D. Have you ever committed a crime, WHETHER ARRESTED OR NOT, which would constitute a felony or first-degree misdemeanor? If “YES”, explain below and provide all related documents, (i.e. police reports, arrest affidavits, court dispositions)
Offense: Click here to enter text.

Date: Click here to enter a date.

Circumstances: Click here to enter text.

Offense: Click here to enter text.

Date: Click here to enter a date.

Circumstances: Click here to enter text.


Offense: Click here to enter text.

Date: Click here to enter a date.

Circumstances: Click here to enter text.


  • Attach additional sheets if necessary

E. Have you ever been arrested or charged with any criminal violation, including notices to appear? If “YES”, explain below and enclose all related documents, (i.e., police reports, arrest affidavits, court dispositions)


Offense: Click here to enter text.

Date: Click here to enter a date.

Circumstances: Click here to enter text.
Offense: Click here to enter text.

Date: Click here to enter a date.

Circumstances: Click here to enter text.
Offense: Click here to enter text.

Date: Click here to enter a date.

Circumstances: Click here to enter text.


  • Attach additional sheets if necessary

F. Have you ever had a criminal record or an arrest record sealed or expunged?

Yes ☐ No ☐ If “YES”, list date Click here to enter a date.

Location (City, State): Click here to enter text.


SPECIAL NOTE: Criminal records sealed under Florida Statutes, as well as most states’ laws, may be available for inspection by a Criminal Justice Agency for the purpose of employment.
G. Have you ever been under investigation by the Tallahassee Police Department or any other law enforcement agency: Yes ☐ No ☐

If “YES” what agency and explain in detail: Click here to enter text.


H. Have you ever been listed as a defendant or plaintiff in a civil suit? Yes ☐ No ☐

If “YES” what agency and explain in detail: Click here to enter text.


I. As part of your background investigation, TPD will check your credit history with a credit bureau, what do you think your report will reflect? Excellent ☐ Fair ☐ Poor ☐

Why? Click here to enter text.


J. Are there any other incidents in your life not mentioned herein which may reflect your suitability for this job or which might require further explanation? Yes ☐ No ☐ If yes, please explain: Click here to enter text.
Should you fail to meet the minimum standards required by the Tallahassee Police Department, you will be immediately discontinued from our hiring process.

For our information, how were you made aware of the Police Officer/Training position?


Location

☐ Recruiter/Job Fair Click here to enter text.

☐ Acquaintance/Officer Click here to enter text.

☐ Job Advertisement Click here to enter text.

☐ Internet/Website Click here to enter text.

☐ Newspaper Click here to enter text.



☐ Other Click here to enter text.


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