CHECK THE POSITION YOU ARE APPLYING FOR:
POLICE OFFICER CERTIFIED OFFICER NON-SWORN POSITION (Please specify: ______________________________________________________
Instructions to the Applicant:
1. Your application must be TYPED or printed legibly in BLACK INK.
2. You are responsible for obtaining correct and complete addresses. If you are not sure of an address, personally verify before making that
entry on the history statement. ALL ADDRESSES MUST BE COMPLETE WITH ZIP CODES.
3. All time periods in your background must be accounted for.
4. You are responsible for furnishing any changes and/or updating your application as needed, such as address changes or telephone
changes in writing.
5. You must respond 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. ALL questions on this application MUST be answered IN FULL before it will be accepted for processing. Failure to
complete the application does not exclude applicant from being hired. Any delay in providing this information will have a negative impact
on your consideration for employment. Intentional omissions or falsifications will result in immediate disqualification.
6. If you need more space for any response, use the supplemental information page on the last page of this form (Page 30) and identify the
additional information by the question number.
7. Below is the list of required documents needed to process your application. Please submit copies of all applicable documents with your
completed Personal History Statement. Do not submit originals. Copies of the requested documents will not be returned to you.
Valid driver’s license
Social Security Card
Certified (Department of Health) Birth Certificate
High school diploma or GED certificate (GED must be accompanied by the test scores)
College degree or transcript from every university attended (sealed originals in envelope) if no degree was
Military DD Form 214
Original Naturalization Certificate, if applicable (No photo copy, applicant will provide this at the time of the initial
Marriage License/Divorce decree
Court Orders (legal separations, adoptions, name changes, and bankruptcy petition/discharge.)
A current copy (past 6 months) of your credit report.
TO THE APPLICANT- IMPORTANT NOTICE!
Employees are exposed to confidential and law enforcement sensitive information. You will be the subject of a complete
background investigation consisting of family, personal, employment, financial, driving and criminal history. A thorough
background investigation is required to properly evaluate the suitability of applicants for employment with the agency. These
instructions are provided as a guide to assist you in properly completing your Personal History Statement. IT IS ESSENTIAL
THAT THE INFORMATION IS ACCURATE IN ALL RESPECTS, SO PLEASE READ ALL INSTRUCTIONS CAREFULLY
BEFORE PROCEEDING. All applicants will be administered a polygraph examination prior to acceptance for employment by
the Manassas City Police Department to determine the truthfulness of the information furnished.
ANY MISSTATEMENT, MISREPRESENTATION, FALSIFICATION OF FACT, OR OMISSION OF ANY INFORMATION
REQUESTED IN THIS APPLICATION OR IN THE HIRING PROCESS WILL PERMANENTLY DISQUALIFY YOU FROM
EMPLOYMENT WITH THE MANASSAS CITY POLICE DEPARTMENT.
“I hereby certify that I have read, understood and agree to the foregoing information and conditions, AS WELL AS THE
INSTRUCTIONS that follow, and further, certify that all of my statements and responses contained herein are, to the best of
my knowledge and belief, true, complete, correct and made in good faith. I understand that knowing and/or a willful false
statement in this Personal History Statement constitutes grounds for immediate disqualification from the hiring process or
termination after I have been employed. I understand that I must pass a polygraph examination and a physical examination
to be considered for employment.”
Signature of Applicant Date
PRINT OR TYPE FULL NAME (FIRST, MIDDLE, LAST)
CITY OF MANASSAS POLICE DEPARTMENT
Applicant Personal History Statement
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Manassas City Police Department
Recruitment / Applicant Investigation Division
9518 Fairview Avenue
Manassas, Virginia 20110
PERSONAL HISTORY STATEMENT
POLICE DEPARTMENT APPLICANT
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