Blank Texas Personal History Statement PDF Form

Blank Texas Personal History Statement PDF Form

The Texas Personal History Statement is a crucial document required for individuals seeking licensure as peace officers or jailers in Texas. This form collects essential personal information, ensuring that applicants meet specific eligibility criteria, including citizenship and educational background. Completing this statement accurately is vital, as any misrepresentation can lead to disqualification.

To begin your application process, please fill out the form by clicking the button below.

The Texas Personal History Statement form is a crucial document for individuals seeking licensure as peace officers or jailers within the state. It serves as a comprehensive questionnaire that gathers essential personal and professional information from applicants. The form requires applicants to confirm their eligibility by meeting specific criteria, including citizenship, educational qualifications, and a clean legal record concerning certain misdemeanors and felonies. Notably, it emphasizes the importance of honesty; any deliberate misrepresentation or omission of information can lead to disqualification. The application process also includes sections for personal details, contact information, and a history of prior law enforcement applications. Additionally, the form contains a section dedicated to family and references, ensuring that applicants provide a complete picture of their background. Throughout the process, applicants are reminded to be thorough and accurate, as this form plays a significant role in the evaluation of their suitability for a position in law enforcement. Understanding the nuances of this form is essential for anyone looking to navigate the licensure process successfully.

Document Sample

DP-1

THE UNIVERSITY OF TEXAS SYSTEM POLICE

PERSONAL HISTORY STATEMENT

APPLICANT NAME

POSITION

Date Issued:

 

Return By:

 

Received On:

Received By:

9.14.11 MT

PERSONAL HISTORY STATEMENT for TEXAS LICENSURE

Instructions to the Applicant

Before you begin to fill out this personal history statement, please ensure that you meet the following requirements. You must meet all five of these requirements to qualify for licensure as a peace officer or jailer in Texas.

I am a citizen of the United States of America.

I have earned a high school diploma or a GED.

I have never been convicted, pleaded guilty to (nolo contendere), nor have I been on court-ordered community service/probation or deferred adjudication for a Class A misdemeanor or a felony.

During the last ten (10) years, I have not been convicted, pleaded guilty to (nolo contendere), been on community service/probation or deferred adjudication for a Class B misdemeanor in this state, other state, or while serving in the military.

I have never had a military court martial that resulted in a dishonorable or bad conduct discharge.

DISQUALIFICATION

There are very few automatic conditions for rejection. Even issues of prior misconduct, employee terminations, and arrests are

usually not, in and of themselves, automatically disqualifying. However, deliberate misstatements or omissions can and often will

result in your application being rejected, regardless of the nature or reason for the misstatements/omissions. In fact, the number one reason individuals “fail” background investigations is because they deliberately withhold or misrepresent job-relevant

information from their prospective employer.

This personal history statement is a governmental document. Be truthful, as there are criminal consequences for being untruthful on a governmental document.

Once you begin:

Type or neatly print, in ink, responses to all items and questions. If a question does not apply to you, write “N/A”

(not applicable) in the space provided for your response. If you cannot obtain or remember certain information, indicate so in your response.

If you need more space for any response, use the last page of this form (page 27) and identify the additional information by the question number.

Be as complete, honest and specific as possible in your responses.

Disclosure of Medically-Related Information

In accordance with the U.S. Americans with Disabilities Act, at this stage of the hiring process applicants are not expected or required to reveal any medical or other disability-related information about themselves in response to questions on this form, or to any other inquiry made prior to receiving a conditional offer of employment.

9.14.11 MT

Initial this page to indicate that you have provided complete and accurate information: _____

PERSONAL HISTORY STATEMENT for TEXAS LICENSURE

SECTION 1: PERSONAL

1. YOUR FULL NAME

1. YOUR FULL NAME

1. YOUR FULL NAME

LAST

FIRST

MIDDLE

2.OTHER NAMES, INCLUDING NICKNAMES, YOU HAVE USED OR BEEN KNOWN BY

3.ADDRESS WHERE YOU RESIDE

NUMBER / STREET

APT / UNIT

CITY

STATE ZIP

4.MAILING ADDRESS, IF DIFFERENT FROM ABOVE

5.CONTACT NUMBERS

 

HOME (

)

 

WORK (

)

EXT

OTHER (

)

CELL

FAX

 

 

 

 

 

 

 

 

 

 

6.

EMAIL ADDRESS

 

 

 

 

 

 

 

 

HOME

 

 

 

 

 

BUSINESS

 

 

 

 

 

 

 

 

 

 

7.

BIRTH PLACE

(CITY / COUNTY / STATE / COUNTRY)

 

 

8. BIRTHDATE

9. SOCIAL SECURITY #

 

 

 

 

 

 

 

 

 

 

10. DRIVER’S LICENSE

 

 

NO.

STATE

EXP

11. PHYSICAL DESCRIPTION

 

HT.

WT.

HAIR COLOR

EYE COLOR

12. Have you ever attended a basic licensing course?

Yes No

 

 

 

 

 

 

If yes, provide the following information: PID:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A)

ACADEMY NAME

 

 

 

FROM

TO

DID YOU GRADUATE?

 

 

 

 

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION

(CITY / STATE)

 

NAME OF TRAINING OFFICER / ACADEMY

CONTACT NUMBER

 

 

 

 

 

COORDINATOR

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

B)

ACADEMY NAME

 

 

 

FROM

TO

DID YOU GRADUATE?

 

 

 

 

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION

(CITY / STATE)

 

NAME OF TRAINING OFFICER / ACADEMY

 

CONTACT NUMBER

 

 

 

 

 

COORDINATOR

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

13.Have you ever applied to any other law enforcement agency in the last ten years (city, county, state or federal)?...

Yes

No

If yes, list ALL agencies you have applied to, starting with the most recent (give complete and accurate addresses).

All agencies MUST be listed regardless of the outcome or current status. Check all boxes that apply for each agency.

If more space is needed, continue your response on page 27.

A) NAME OF AGENCY

DATE APPLIED

 

 

ADDRESS (NUMBER / STREET)

BACKGROUND INVESTIGATOR’S NAME (IF KNOWN)

CITY

 

 

 

 

ZIP

 

CONTACT NUMBER

 

EXT

 

 

 

 

STAT

 

 

(

)

 

 

 

POSITION APPLIED FOR

 

 

 

 

 

 

EMAIL

 

 

 

 

 

 

 

 

 

 

Check each step in the process that you completed, and your status:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STEPS:

Application

Written

Physical agility

Oral

Polygraph/CVSA

Background

Chief’s oral

Conditional job offer

 

 

 

 

 

 

 

 

 

 

STATUS:

Hired

On List

Withdrawn

Disqualified

 

 

 

 

9.14.11 MT

Initial this page to indicate that you have provided complete and accurate information: _____

PERSONAL HISTORY STATEMENT for TEXAS LICENSURE

13. Have you ever applied to any other law enforcement agency… continued

B) NAME OF AGENCY

DATE APPLIED

ADDRESS (NUMBER / STREET)

 

 

BACKGROUND INVESTIGATOR’S NAME (IF

 

 

 

KNOWN)

 

 

CITY

 

ZIP

CONTACT NUMBER

 

EXT

 

 

 

STAT

 

(

)

 

 

POSITION APPLIED FOR

 

 

EMAIL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check each step in the process that you completed, and your status:

 

 

STEPS:

Application

Written

Physical agility

Oral

Polygraph/CVSA

Background

Chief’s oral

 

 

Conditional job offer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATUS:

 

Hired

On List

Withdrawn

Disqualified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) NAME OF AGENCY

 

 

 

 

 

 

 

 

DATE APPLIED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

(NUMBER / STREET)

 

 

 

 

 

 

BACKGROUND INVESTIGATOR’S NAME (IF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

KNOWN)

 

 

 

 

 

 

CITY

 

 

 

 

 

ZIP

 

CONTACT NUMBER

 

EXT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STAT

 

 

 

(

)

 

 

 

 

 

 

POSITION APPLIED FOR

 

 

 

 

 

 

 

EMAIL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check each

step in the process that you completed, and your status:

 

 

 

 

 

 

 

 

 

 

STEPS:

Application

Written

Physical agility

Oral

Polygraph/CVSA

Background

Chief’s oral

 

 

 

Conditional job offer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATUS:

 

Hired

On List

Withdrawn

Disqualified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 2: RELATIVES AND REFERENCES

14.IMMEDIATE FAMILY

Provide all applicable information in the spaces below.

Mark “N/A” if a category is not applicable or if the individual is deceased.

If more space is needed, continue your response on page 27.

N/A A. Father

NAME

HOME ADDRESS

(NUMBER / STREET / APT)

CITY

STATE

ZIP

 

 

 

 

 

 

HOME PHONE

WORK ADDRESS

(NUMBER / STREET / APT)

CITY

STATE

ZIP

()

 

 

WORK PHONE

CELL PHONE

 

EMAIL

 

 

 

(

)

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

B. Step-father

 

 

 

 

 

 

 

 

NAME

 

 

HOME ADDRESS

(NUMBER / STREET / APT)

CITY

STATE

ZIP

 

 

 

 

 

 

 

 

 

 

HOME PHONE

WORK ADDRESS

(NUMBER / STREET / APT)

CITY

STATE

ZIP

 

(

)

 

 

 

 

 

 

 

 

 

 

WORK PHONE

CELL PHONE

 

EMAIL

 

 

 

 

(

)

 

(

)

 

 

 

 

 

9.14.11 MT

Initial this page to indicate that you have provided complete and accurate information: _____

File Specifics

Fact Name Details
Governing Law The Texas Personal History Statement is governed by the Texas Occupations Code, Chapter 1701, which outlines the requirements for peace officer licensure.
Eligibility Requirements Applicants must be U.S. citizens, have a high school diploma or GED, and meet specific legal criteria regarding prior convictions.
Disqualification Criteria Automatic disqualification is rare. However, intentional misstatements or omissions can lead to rejection of the application.
Medical Disclosure Under the Americans with Disabilities Act, applicants do not need to disclose medical conditions until a conditional job offer is made.
Submission Instructions Responses must be typed or printed in ink. If a question does not apply, "N/A" should be indicated.
Background Investigation Failure to provide complete and honest information is the leading cause of failure in background investigations for applicants.
Additional Information If more space is needed for responses, applicants should use the last page of the form and reference the question number.

How to Use Texas Personal History Statement

Filling out the Texas Personal History Statement form is an essential step for individuals seeking licensure as a peace officer or jailer in Texas. Completing this form accurately and thoroughly will help ensure a smooth application process. Below are the steps to follow when filling out the form.

  1. Begin by reviewing the eligibility requirements to ensure you qualify for licensure.
  2. Type or neatly print your responses in ink for clarity.
  3. In Section 1, provide your full name, including any other names or nicknames you have used.
  4. Fill in your current address, mailing address (if different), and contact numbers.
  5. Provide your email address, birth place, birth date, and Social Security number.
  6. Enter your driver's license number and state of issuance, along with its expiration date.
  7. Complete the physical description section, including height, weight, hair color, and eye color.
  8. If applicable, indicate whether you have attended a basic licensing course and provide the requested details.
  9. List any law enforcement agencies you have applied to in the past ten years, including complete addresses and contact information.
  10. Check off the steps in the application process that you completed and indicate your current status.
  11. In Section 2, provide details about your immediate family, including names, addresses, and contact information. Mark “N/A” where appropriate.
  12. Ensure you have initialed the pages where required to confirm the accuracy of the information provided.
  13. Review the entire form for completeness and accuracy before submission.

Your Questions, Answered

What is the Texas Personal History Statement form used for?

The Texas Personal History Statement form is a crucial document for individuals seeking licensure as peace officers or jailers in Texas. It collects essential personal information and background details to ensure applicants meet the necessary qualifications. This includes verifying citizenship, educational achievements, and criminal history. The information provided helps law enforcement agencies conduct thorough background checks, which are vital for maintaining public safety and trust in law enforcement.

What are the requirements to fill out the Personal History Statement?

To qualify for licensure as a peace officer or jailer in Texas, applicants must meet five specific requirements:

  1. Be a citizen of the United States.
  2. Have earned a high school diploma or a GED.
  3. Have no convictions or guilty pleas for Class A misdemeanors or felonies.
  4. Not have any Class B misdemeanor convictions in the last ten years.
  5. Never have received a dishonorable or bad conduct discharge from the military.

Meeting these requirements is essential for the application process to proceed smoothly.

What should I do if I cannot remember certain information required on the form?

If you encounter questions on the form that you cannot answer due to a lack of information or memory, it is important to indicate this in your response. You can write “N/A” (not applicable) in the space provided. Additionally, if you need more space to elaborate on your answers, you can use the last page of the form and clearly identify the question number you are addressing. Being honest about your situation is crucial, as it reflects your integrity during the application process.

What happens if I provide false information on the form?

Providing false information on the Texas Personal History Statement can have serious consequences. This form is a governmental document, and any deliberate misstatements or omissions can lead to rejection of your application. In fact, the primary reason many applicants fail background investigations is due to withholding or misrepresenting job-relevant information. It is vital to be truthful, as there can be criminal repercussions for dishonesty on such documents.

Common mistakes

  1. Omitting Required Information: Failing to provide all necessary details, such as addresses or contact numbers, can lead to delays or rejection of the application.

  2. Inaccurate Information: Providing false or misleading information, even unintentionally, can result in disqualification. Always verify details before submission.

  3. Ignoring “N/A” Responses: Not marking questions that do not apply to you with “N/A” can confuse reviewers and may suggest incomplete information.

  4. Failure to Sign or Initial: Neglecting to sign or initial the required pages may indicate that the applicant has not verified the information provided.

  5. Not Using the Correct Format: Responses should be typed or printed clearly in ink. Illegible handwriting can lead to misunderstandings or errors.

  6. Overlooking Additional Space: If more space is needed for responses, applicants must use the designated area on the last page and reference the question number.

  7. Neglecting Background History: Failing to list all previous law enforcement agency applications, regardless of the outcome, can raise red flags during the background check.

Documents used along the form

When applying for a position as a peace officer or jailer in Texas, the Texas Personal History Statement form is just one of several important documents you will need to prepare. Each of these documents plays a critical role in ensuring that your application is complete and that you meet the necessary qualifications. Below is a list of other commonly required forms and documents that often accompany the Texas Personal History Statement.

  • Background Investigation Release Form: This document grants permission for the hiring agency to conduct a thorough background check. It typically includes your personal information and may require you to disclose past employment, criminal history, and other relevant details.
  • Medical History Questionnaire: This form collects information about your health and any medical conditions that may affect your ability to perform the duties of a peace officer. While you are not required to disclose certain medical information until a conditional job offer is made, this questionnaire helps assess your fitness for the role.
  • Driver’s License Record: A copy of your driving record may be required to ensure that you have a valid driver's license and a clean driving history. This is crucial since many law enforcement positions require driving as part of the job.
  • Proof of Education: You will need to provide documentation that verifies your educational background, such as a high school diploma or GED certificate. This is essential to confirm that you meet the educational requirements for licensure.
  • References List: A list of personal and professional references is often requested. These individuals can vouch for your character, work ethic, and suitability for a position in law enforcement. It’s important to choose references who can provide positive and relevant feedback about your qualifications.

Gathering these documents can seem overwhelming, but being well-prepared will streamline the application process. Each form serves a specific purpose in evaluating your qualifications and suitability for a career in law enforcement. Take the time to fill them out carefully and truthfully, as this can significantly impact your chances of success.

Similar forms

The Texas Personal History Statement form shares similarities with the FBI Background Check form. Both documents require applicants to disclose personal information, including their full name, address, and Social Security number. The FBI form also asks for details about previous arrests and convictions, similar to the Texas form's inquiries about criminal history. Both are crucial for ensuring the integrity and safety of individuals in positions of trust, especially in law enforcement.

Another comparable document is the Federal Employment Background Investigation form. This form, like the Texas Personal History Statement, collects extensive personal data, including employment history and references. Both documents emphasize the importance of honesty and accuracy, as misrepresentations can lead to disqualification. They serve to vet candidates thoroughly before granting access to sensitive government positions.

The National Crime Information Center (NCIC) Application is another document with parallels. It also requires applicants to provide detailed personal and criminal history information. The NCIC Application is used to determine eligibility for access to criminal justice information, just as the Texas Personal History Statement assesses suitability for law enforcement roles. Both forms underline the necessity of transparency in the application process.

Similar to the Texas Personal History Statement, the Department of Defense Security Clearance Application gathers personal history to evaluate an individual’s trustworthiness. This document requires information about family members, residences, and financial history. Both applications aim to mitigate risks by ensuring that candidates have no significant issues that could compromise their integrity or reliability.

The Application for Employment with a Law Enforcement Agency has much in common with the Texas Personal History Statement. Both documents require candidates to disclose their educational background, employment history, and references. They also emphasize the need for complete and truthful responses, as any discrepancies can lead to disqualification from the hiring process.

The State Licensing Application for Professional Licensure is another relevant document. This application, similar to the Texas Personal History Statement, requires individuals to provide personal and professional history, including any disciplinary actions or criminal convictions. Both documents are designed to ensure that applicants meet the ethical and legal standards necessary for their respective professions.

Finally, the Pre-Employment Questionnaire used by many private employers also resembles the Texas Personal History Statement. This questionnaire collects personal data, employment history, and references. Like the Texas form, it stresses the importance of accuracy and honesty, as misrepresentation can result in immediate disqualification from the hiring process. Both documents play a critical role in evaluating the suitability of candidates for employment.

Dos and Don'ts

When filling out the Texas Personal History Statement form, there are several important dos and don’ts to keep in mind. Following these guidelines can help ensure that your application is processed smoothly.

  • Do read all instructions carefully before starting the form.
  • Do provide accurate and truthful information for every question.
  • Do type or neatly print your responses in ink.
  • Do indicate “N/A” for questions that do not apply to you.
  • Do use the last page for additional information if needed.
  • Don’t omit any relevant information, as this could lead to rejection.
  • Don’t provide false information; this can have serious consequences.
  • Don’t forget to initial the page to confirm the accuracy of your information.
  • Don’t disclose any medical information until after a conditional job offer.

By following these guidelines, you can help ensure that your application stands the best chance of success.

Misconceptions

  • Misconception 1: The Personal History Statement is optional.
  • This form is a required part of the application process for licensure as a peace officer or jailer in Texas. Completing it accurately is essential for consideration.

  • Misconception 2: Only serious criminal convictions lead to disqualification.
  • While serious convictions can disqualify an applicant, minor offenses or past misconduct may not automatically result in rejection. However, intentional misstatements or omissions can lead to disqualification.

  • Misconception 3: Medical information must be disclosed at this stage.
  • Applicants are not required to reveal any medical or disability-related information until they receive a conditional offer of employment. This protects privacy and complies with the Americans with Disabilities Act.

  • Misconception 4: It is acceptable to skip questions that do not apply.
  • Applicants should write “N/A” for questions that do not apply to them. This shows that they have considered each question and are providing complete information.

  • Misconception 5: The form can be filled out carelessly.
  • Completing the form with care is crucial. Inaccurate or incomplete information can lead to rejection of the application. It is important to be thorough and honest in all responses.

Key takeaways

Key Takeaways for Filling Out the Texas Personal History Statement Form:

  • Ensure you meet all eligibility requirements before starting the form. You must be a U.S. citizen, have a high school diploma or GED, and have no serious criminal history.
  • Be truthful. Misstatements or omissions can lead to rejection of your application, regardless of the context.
  • Use clear handwriting or type your responses. If a question does not apply, write “N/A” in the space provided.
  • Complete all sections thoroughly. If you need extra space, use the last page of the form and reference the question number.
  • Do not disclose any medical information at this stage. The Americans with Disabilities Act protects you from having to share this information until a conditional job offer is made.
  • Initial the pages to confirm that you have provided complete and accurate information. This step is crucial for the integrity of your application.
  • List all law enforcement agencies you have applied to in the past ten years, regardless of the outcome. This includes providing detailed addresses and status updates for each application.