DALLAS/FORT WORTH INTERNATIONAL AIRPORT

DEPARTMENT OF PUBLIC SAFETY

PERSONAL HISTORY STATEMENT

POLICE OFFICER

Applicant: _____________________ _

Telephone: _____________________ _ Home Cell

Drivers License: __________ State Issued: ______ _

TCOLE PID:____________________ N/A

Branch:____________________________ Years:_______________

College Hours Completed: _______ _ D N/A

Years:_______ Police Experience : Yes No

Military Service: Yes No

Home Address:__________________________________________________________________Street Address City State Zip

Social Security Number:_________________________________ Email:__________________________________

Date of Birth:____________________ How did you hear about us? (Please be specific.)__________________

NOTICE TO APPLICANTS

INSTRUCTIONS FOR COMPLETING THE PERSONAL HISTORY STATEMENT

READ THESE INSTRUCTIONS CAREFULLY BEFORE PROCEEDING

These instructions are provided as a guide to assist you in completing the Personal History Statement (PHS). You are responsible for all information that you provide in your Personal History Statement. All the information you provide must be accurate and complete. The information you provide will be used to complete a background investigation that will determine your eligibility for employment. Submitting an incomplete Personal History Statement will result in your termination in the application process.

1. Read the instructions in its entirety prior to completing the Personal History Statement.2. Gather all your information, check for accuracy and place in proper sequence prior to beginning PHS.

5. Accurately answer all questions. If a question does not apply to you, enter N/A in the space provided.DO NOT LEAVE ANY BLANKS.

6. Deliberately omitting or misrepresenting facts will result in the termination of your application process.7. You are responsible for collecting all the information requested in this PHS. Check for accuracy prior to providing

the information.8. Page 2 lists the documents that are required to be returned with the PHS.9. Once completed, print all pages of the PHS including all forms requiring notarization.

10. All forms requiring notarization must be done prior to submission to the DFW Airport Police Department.11. This page must be notarized.

The Personal History Statement is important for the processing of your application to become a police officer. Neatness, punctuation, spelling and the ability to follow written/verbal directions are evaluated as part of the application process. An incomplete Personal History Statement will be rejected.

Warning: THIS DOCUMENT IS A GOVERNMENTAL RECORD. KNOWINGLY MAKING A FALSE ENTRY IN A GOVERNMENTAL DOCUMENT IS A FELONY, PURSUANT TO TEXAS PENAL CODE SECTION 37.10.

I, the undersigned, have read and understand the instructions and warning. I understand that any falsifications or omissions in this Personal History Statement will result in my application being terminated, as any such act would constitute a criminal act. I further acknowledge that once this Personal History Statement and required documents are submitted they become the property of Dallas/Fort Worth Department of Public Safety. THESE DOCUMENTS WILL NOT BE RETURNED.

________________________________________________________________________________________________________ Applicants Signature/ Affiant Date

Sworn to and subscribed before me this _________ day of__________________________, 20 _______

Notary Public____________________________________________________________________________________________

My Commission Expires___________________________________________________________________________________

3. Your Personal History Statement must be TYPED ONLY by you. A handwritten PHS WILL NOT be accepted.Do not use the back of any page for any purpose in this PHS. This includes printing double sided.4.

DOCUMENTS TO BE SUBMITTED WITH THE PERSONAL HISTORY STATEMENT

The following documents are required to confirm your eligibility to continue in the application process and to complete your application phase. Please submit copies of all documents EXCEPT High School and College Transcripts. These documents must be submitted, if applicable, with the Personal History Statement.

1. Birth Certificate or Naturalization Papers2. High School Transcript and/or G.E.D. - Include Official transcripts from every High School attended.

Must be received in an envelope sealed by the school.3. College Transcripts - Include Official transcripts from every college attended. Must be received in an

envelope sealed by the college.4. Military Form DD214 (Long Form). - Include all DD214 received. If still active military, include a

letter from the Commanding Officer stating the you are in good standing and will be honorablydischarged prior to the completion of the hiring process.

5. Marriage License(s) and Divorce Decree(s) to include all pages for each marriage and/or divorce6. Driver’s License7. Social Security Card8. Passport, current or expired to include all pages9. Automobile Liability Insurance Card10. Licenses and Training Certificates11. Any other documents relating to significant incidents in your life (including, but not limited to,

bankruptcies, lawsuits, military discipline, commendation letters, letters of reprimand, arrest, etc.) Pleaseinclude all pages.

12. High School Diploma or GED Certificate13.

THIS PHOTOGRAPH IS FOR IDENTIFICATION PURPOSES ONLY.

Attach a photograph of yourself taken within the last 90 days.

Attach the photo securely here with paste or tape.

Print your name on the back of the photograph.

*IMPORTANT: If you are unable to obtain any required information for whatever reason within the 21-day period allotted, awritten explanation is required (i.e. original birth certificate, official high school and/or college transcripts).

Certified Copy of Court Disposition Paperwork (for offenses classified as a Class B Misdemeanor and above)

DOCUMENTS SHOULD BE PHOTOCOPIED PRIOR TO SUBMISSION. COPIES WILL NOT BE MADE FOR YOU.

Dallas/Fort Worth International Airport Department of Public Safety

Importance of Honesty

The Dallas/Fort Worth International Airport Department of Public Safety is seeking public safety applicants who demonstrate certain characteristics. Honesty is the most important characteristic that you must demonstrate. It is extremely important that you are completely honest in all of your answers.

The importance of honesty from the time of application, completion of all documents, questionnaires and the Personal History Statement as well as during all interviews cannot be over emphasized. Failure to respond to any question accurately and completely, whether verbally or in writing, will result in your application being removed from the process. Deception is the primary reason why applicants are disqualified in the selection process.

While filling out documents, you are cautioned to take your time and to be thorough and specific in all your answers. If you have any doubt in your mind concerning a particular question, or if you are unaware whether to include certain information, the answer is, "Yes, include it."

You may think that something you have done will disqualify you from further consideration. It may or may not. What will certainly disqualify you is failing to disclose information or distorting the truth. For example, an arrest (whether when you were a juvenile or adult) may or may not disqualify you. However, failing to disclose this information will disqualify you from further consideration. Or, you may have been fired from a job, which by itself, may or may not disqualify you. However, failing to disclose this information will disqualify you from further consideration. The use of drugs, including marijuana, may or may not disqualify you. However, failing to disclose this information will disqualify you from further consideration.

I HAVE READ AND UNDERSTAND THE IMPORTANCE OF BEING HONEST THROUGHOUT THIS ENTIRE PROCESS.

______________________________________________________________________________________________________ Applicants Signature/ Affiant Date

Sworn to and subscribed before me this _________ day of__________________________, 20 _______

Notary Public____________________________________________________________________________________________

My Commission Expires___________________________________________________________________________________

Before me, the undersigned authority, on this day personally appeared the person whose signature is affixed upon the line

designed (AFFIANT).

I who after being duly sworn, acknowledged that the release hereinabove set out was executed by him/her voluntarily and

knowingly for the purposes therein set out.

Sworn to and subscribed before me this __________ day of ________________________, 20 _________

Notary Public ______________________________________

My commission expires ______________________________

that there are no willful misrepresentations, omission, or falsifications in the

I further understand that all statements will be verified through a background investigation and

Before me, the undersigned authority, on this day personally appeared the person whose signature is affixed upon the line

designed (AFFIANT).

I who after being duly sworn, acknowledged that the release hereinabove set out was executed by him/her voluntarily and

knowingly for the purposes therein set out.

Sworn to and subscribed before me this __________ day of ________________________, 20 _________

Notary Public ______________________________________

My commission expires ______________________________

A thorough investigation will be conducted to determine your qualifications for the position of police officer. To a great extent, your employment will depend on information obtained in confidential interviews with persons with who you have been associated. Information obtained will be confidential and the department may release contents to personnel as necessary with proper documentation. If your application rejection is of a temporary nature whereby you could be accepted at a later date, you will be so notified upon request. I have read and fully understand the above statement.

rtment of Public Safety

and to any duly authorized agent of the Department of Public Safety, whether said

Public Safety investigators regarding any aspects of

any attempt to comply with such. I direct you to release such information upon request of the duly authorized

application is considered confidential and the Dallas/Fort Worth International Airport Department of Public Safety reserves the right to restrict release of any and all material based on the nature and confidentiality of such material.

Grapevine, Dallas, Fort Worth, Euless, Coppell and Irving, their agents, servants, and employees and the Dallas/Fort Worth International Airport Board.

Applicant's Signature/Affiant

_________________________________________ Applicant’s Name/Affiant (Please Print)

_________________________________________ Date

_________________________________________ Applicant’s Signature/Affiant

ACKNOWLEDGEMENT

Before me, the undersigned authority, on this day personally appeared the person whose signature is affixed upon the line

designed (AFFIANT).

I who after being duly sworn, acknowledged that the release hereinabove set out was executed by him/her voluntarily and

knowingly for the purposes therein set out.

Sworn to and subscribed before me this __________ day of ________________________, 20 _________

Notary Public ______________________________________

My commission expires ______________________________

RELEASE FOR POLICE APPLICANTS

TO WHOM IT MAY CONCERN:

I, the undersigned, do hereby request and specifically authorize N-DEx (The National Data Exchange), to release to the

bearer hereof, an authorized representative and member of the DFW Airport Department of Public Safety, any and all

information that you might have in your care, custody, and control which relates to myself. I am fully aware of the fact that

this information will be used in conjunction with the conducting of a background investigation which is being undertaken by

the DFW Airport Department of Public Safety pursuant to an application for employment which I have filed with the

Department. I hereby release N-DEx (The National Data Exchange), all agents and employees, from any and all liability

and/or damage which may result from furnishing the information hereinabove referred to. I understand that all

information obtained through the use of this waiver is deemed confidential and that such information will not be released

to this affiant.

_________________________________________ Applicant’s Name/Affiant (Please Print)

_________________________________________ Date

_________________________________________ Applicant’s Signature/Affiant

ACKNOWLEDGEMENT

Before me, the undersigned authority, on this day personally appeared the person whose signature is affixed upon the line

designed (AFFIANT).

I who after being duly sworn, acknowledged that the release hereinabove set out was executed by him/her voluntarily and

knowingly for the purposes therein set out.

Sworn to and subscribed before me this __________ day of ________________________, 20 _________

Notary Public ______________________________________

My commission expires ______________________________

I authorize any employee or representative of DFW Airport Department of Public Safety to search N-DEx to obtain information regarding my qualifications and fitness to serve as a Police Officer. I understand that N-DEx is an electronic repository of information from federal, state, local, tribal, and regional criminal justice entities. This national information sharing system permits users to search and analyze data from the entire criminal justice cycle, including crime incident and investigation reports; arrest, booking, and incarceration reports; and probation and parole information. This release is executed with full knowledge, understanding, and consent that any information discovered in N-DEx may be used for the official purpose of conducting a complete employment background investigation. I also understand that any information found in N-DEx will not be disclosed to any other person or agency unless authorized and consistent with applicable law. I release DFW Airport Department of Public Safety from any liability or damage that may result from the use of information obtained from N-DEx.

_________________________________________________________________

Race/Ethnicity: (Check One)

Other

Street/PO Box

CHILDREN AND DEPENDENTS

If Yes, Explain:____________________________________________________________________________________________________________________________________________

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Trade/Vocational/Technical School

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Dates Attended

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Fair - Can Navigate Foreign Country, Communicate With Other Speakers, etc. Good - Conversational, Almost FluentExcellent - Completely Fluent

Indicate type of special license such as pilot, radio operator, etc. Show licensing authority where license

Unable to Reenlist

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Yes No

Do you have a bank account?

Primary Checking Account (last four) #

Primary Savings Account (last four) #

Yes No

etc.

If yes, provide the following for all vehicles:

Yes No

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BrotherSister

BrotherSister

BrotherSister

Sister

SisterBrother

Brother

BrotherSister

Brother In-law Sister In-law

Brother In-law Sister In-law

Brother In-law Sister In-law

Brother In-law Sister In-law

Brother In-law Sister In-law

Brother In-law Sister In-law

Agency

Agency

Agency

Agency

Yes No

Have you EVER been arrested for ANY reason?

Yes No

Yes No

example: experimentation, tried, taking a hit, etc.

List all active, inactive and closed social media accounts. Provide social media website and username, reason for opening accounts and reason closed account if applicable.

Please provide all Law Enforcement agencies applied with for employment as a police recruit, police officer or agent.

Do you have a passport? Yes No

SECTION 29: ESSAY

Respond to the following question by writing your response in no less than 250 words.

Please write a short narrative describing why you want to become a police officer for DFW Airport and what would make you a good DFW Airport police officer. Include any professional training as well as your individual characteristics and skills.

If you are currently or have been employed as a police officer, tell us what makes or made you a goodpolice officer and why you want to work for DFW Airport Police Department.