The Alaska F 3 form is a Personal History Statement required by the Alaska Police Standards Council (APSC) for individuals seeking certification as law enforcement officers. This form collects essential personal information to assist in the background investigation process, ensuring that applicants meet the necessary qualifications. Completing this form accurately is crucial for a successful application; therefore, applicants should provide truthful and comprehensive responses.
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The Alaska F-3 form, also known as the Personal History Statement, serves a critical role in the application process for individuals aspiring to become certified officers under the Alaska Police Standards Council (APSC). This comprehensive document requires applicants to provide detailed personal information, including their full name, contact details, and citizenship status, along with a thorough account of their family background and references. It is essential for applicants to fill out this form accurately and completely, as the information collected will be used in a background investigation to assess their suitability for the position. The form also emphasizes the importance of honesty; any deliberate misstatements or omissions can lead to disqualification from the application process. Additionally, applicants are reminded that they are not obligated to disclose any medical information, in compliance with federal regulations. Completing the Alaska F-3 form is a significant step in a candidate's journey toward a career in law enforcement, and understanding its requirements can greatly enhance the likelihood of a successful application.
Alaska Police Standards Council
PO Box 111200
Juneau, Alaska 99811
Instructions to the Applicant
The information you provide in this Personal History Statement will be used in the background investigation to assist in determining your suitability for the position of an APSC Certified Officer, in accordance with Alaska Police Standards Council (APSC) regulations.
•Please confirm this version is the most current version by checking APSC website: https://dps.alaska.gov/APSC/Agency-Forms
•It is your responsibility to complete this form and provide all required information.
•If filling out hardcopy, please fill out form in blue or black ink or type as indicated by the agency. Do not use pencil.
•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.
•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.
•Send the completed form to your background investigator or the agency to which you are applying. Do NOT send the form to APSC.
Disqualification
There are very few automatic bases for rejection. Even issues of prior misconduct, such as prior illegal drug use, driving under the influence, theft, or even arrest or conviction 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.
BOTTOM LINE: You are responsible for providing complete, accurate, and truthful responses.
Disclosure of Medically-Related Information
In accordance with the U.S. Americans with Disabilities Act, and the Genetic Information Nondiscrimination Act (GINA), applicants are not expected or required to reveal any medical or other disability-related information about themselves or their family members in response to questions on this form.
I have read and I understand the above instructions.
Signature: _________________________________________________ Date: ________________________
APSC Form F-3
Page 2
SECTION 1: PERSONAL
1.YOUR FULL NAME
LAST
FIRST
MIDDLE
2.OTHER NAMES YOU HAVE USED OR BEEN KNOWN BY (INCLUDE MAIDEN NAME AND NICKNAMES)
3.ADDRESS WHERE YOU LIVE
NUMBER / STREET
APT / UNIT
N/A
CITY
STATE
ZIP
4.MAILING ADDRESS, IF DIFFERENT FROM ABOVE (FOR EXAMPLE, PO BOX)
5.CONTACT NUMBERS
CELL
WORK
HOME
OTHER
TYPE:
6. CONTACT EMAIL
7. LIST ALL OTHER EMAIL ADDRESSES (SEPARATED BY COMMAS)
• Attach a copy of birth certificate or passport or if applicable certification of naturalization (mandatory)
8. CITIZENSHIP
Are you a U.S. citizen?
Yes
No
IF NATURALIZED, provide your certificate number and date, place, and court naturalized
9.BIRTH PLACE (CITY / COUNTY / STATE / COUNTRY) 10. BIRTHDATE (MM/DD/YYYY) 11. SOCIAL SECURITY NUMBER 12. DRIVER’S LICENSE
NUMBER:
STATE:
EXPIRES:
13. PHYSICAL DESCRIPTION
EYE COLOR:
HEIGHT:
WEIGHT:
HAIR COLOR:
13.1SCARS, MARKS, AND TATOOS (include removed or altered tatoos)
SECTION 2: RELATIVES AND REFERENCES
14.IMMEDIATE FAMILY
•Provide all applicable information in the spaces below. • Mark “Deceased,” if appropriate. Mark "N/A" if a category is not applicable
•If more spaced is needed, use Section 15 or continue on page 27 – reference corresponding numbers.
14.A
Spouse / Domestic Partner / Boyfriend / Girlfriend / Significant
Other
Deceased
NAME
HOME ADDRESS (NUMBER / STREET / APT)
HOME PHONE
MAILING ADDRESS (NUMBER / STREET / SUITE)
WORK PHONE
CELL PHONE
EMAIL
DATE OF MARRIAGE/REGISTRATION
BIRTHDATE (MM/DD/YYYY)
Is there, or has there ever been, a civil or criminal restraining or stay-away
(MM/YYYY)
order in effect involving you and this individual?
14.B
Former Spouse/Domestic Partner/Significant Other or Boyfriend/Girlfriend dated longer than three months
DATE OF DISSOLUTION
Ver. 11/22/2019
Initial here to verify you have provided complete and accurate information:
Page 3
SECTION 2: RELATIVES AND REFERENCES continued
14.C Parents / Guardians
List ALL parents/guardians, living or deceased, including biological, adoptive, foster, step-parents, in-laws, etc.
14.C.1 Parent / Guardian:
Mother
Father
Step-mother
Step-father
In-law
Other:
MAILING ADDRESS (IF DIFFERENT)
STATE ZIP
14.C.2 Parent / Guardian:
14.C.3 Parent / Guardian:
14.C.4 Parent / Guardian:
14.D Brothers / Sisters
List ALL LIVING siblings, including half-siblings, step-siblings, foster-siblings, etc.
14.D.1 Sibling:
Brother
Sister
Half-brother
Half-sister
AGE
14.D.2 Sibling:
Page 4
14.D.3
Sibling:
14.D.4
14.E Children
List ALL LIVING children, including natural, adopted, step, and/or foster care. Include any other children who reside with you. Provide the name and contact information of the custodial parent/guardian, if other than you.
14.E.1 Child:
Son
Daughter
Biological Parents:
CUSTODIAL PARENT/GUARDIAN (IF OTHER THAN YOU)
DATE OF BIRTH
ADDRESS (NUMBER / STREET / APT)
CONTACT NUMBER
14.E.2 Child:
14.E.3 Child:
14.E.4 Child:
Page 5
15.LIST OF REFERENCES
•List at least 5 people who know you well, such as close personal relationships, social and family friends, former spouses and significant others, teachers, military colleagues, and/or co-workers. Do NOT include relatives, employers, housemates, or any individuals listed elsewhere.
NAME OF REFERENCE
15.1
How do you know this person?
How long have you known this person?
15.2
15.3
15.4
15.5
15.6
Page 6
15.7
15.8
15.9
15.10
SECTION 3: EDUCATION
•You will be required to furnish unopened official transcripts or other proof to support all of your educational claims before hire or certification.
•If more space is needed, continue your response on page 27.
16. CHECK APPLICABLE
MM/YYYY
High School Diploma:
GED:
WHAT LANGUAGE(S) DO YOU SPEAK?
17.LIST HIGH SCHOOL(S) ATTENDED
NAME OF HIGH SCHOOL
FROM (MM/YYYY)
TO (MM/YYYY)
17.1
PUBLIC/PRIVATE OR HOMESCHOOL?
17.2
PUBLIC, PRIVATE, OR HOMESCHOOL?
Page 7
SECTION 3: EDUCATION continued
18.LIST ALL COLLEGES AND UNIVERSITIES ATTENDED
NAME OF COLLEGE/UNIVERSITY
TOTAL UNITS COMPLETED
18.1
QTR SYSTEM
SEM SYSTEM
ADDRESS (NUMBER / STREET)
TYPE OF DEGREE EARNED
MAJOR / AREA OF STUDY
18.2
QTR SYSTEM SEM SYSTEM TYPE OF DEGREE EARNED
18.3
18.4
19.LIST ALL TRADE, VOCATIONAL, AND BUSINESS SCHOOLS / INSTITUTES ATTENDED
19.1
NAME OF TRADE, VOCATIONAL, OR BUSINESS SCHOOL/INSTITUTE
DID YOU COMPLETE THE COURSE?
STATE TYPE OF SCHOOL OR TRAINING
19.2
20. Have you ever taken an Arrest and/or Firearms Course?
IF YES, provide the following information:
A. COURSE PRESENTER NAME
LOCATION (CITY / STATE)
B. COURSE COMPLETION
COMPLETION DATE (MM/YYYY)
Did you successfully complete the course?
21. Have you ever attended a Basic Law Enforcement Academy: Police, Corrections, Probation/Parole, Village Police
......................
21.1
NAME OF ACADEMY
LOCATION (CITY, STATE)
NAME OF TRAINING OFFICER / ACADEMY COORDINATOR
DID YOU PASS/GRADUATE?
Yes No
21.2
Page 8
22.Have you ever been subject to any disciplinary action, including academic probation, civil fine, suspension, expulsion, or resignation
from any high school(s), college/university, business, trade school, or basic course/academy?
IF YES, describe in detail below. Starting with high school, list any and all disciplinary actions received in any school, educational institution, or basic course. Include when the disciplinary action(s) occurred, name of school(s), and explanation of circumstances.
SECTION 4: RESIDENCE HISTORY
23.LIST OF RESIDENCES
•List all residences during the last 10 years or since age 15.
•Provide complete addresses (include markers such as Street, Drive, Road, East, West, etc., and unit/apt number). Do NOT use PO Boxes.
•If the residence is a military base, identify name of base in address, nearest city, state, and zip code. Do NOT list military barracks mates unless you shared individual quarters.
ADDRESS WHERE YOU NOW LIVE (NUMBER / STREET / APT)
23.1
Present
IF RENTING: PROPERTY MANAGER, RENT COLLECTOR, OR OWNER
MAILING ADDRESS OF PROPERTY MANAGER, RENT COLLECTOR, OR OWNER (NUMBER / STREET / APT / PO BOX)
Name(s) of those with whom you live:
FORMER ADDRESS (NUMBER / STREET / APT)
23.2
Name(s) of those with whom you lived:
Reason for moving:
23.3
Page 9
SECTION 4: RESIDENCE HISTORY continued
23.4
23.5
24.LIST OF HOUSEMATES
•Provide contact information for all housemates listed in Question 23 with whom you have resided during the past 10 years or since age 15.
•Do NOT list anyone for whom you have already provided contact information.
NAME OF HOUSEMATE
24.1
CURRENT ADDRESS IF DIFFERENT (NUMBER / STREET / APT)
NATURE OF RELATIONSHIP (E.G., RELATIVE, LANDLORD, FRIEND, HOUSEMATE ONLY, ETC.)
24.2
24.3
24.4
Page 10
24.5
24.6
24.7
25. Have you ever been evicted or asked to leave a residence?
26. Have you ever left a residence with unpaid damage, owing rent, utilities, or other household expenses?
If you answered “YES” to Questions 25 and/or 26, explain (include when, where, and circumstances):
SECTION 5: EXPERIENCE AND EMPLOYMENT
27.JOB EXPERIENCE
•List ALL jobs you have had in last 10 years, including part-time, temporary, self-employment, and volunteer. (Begin with your most current.)
•If you have military experience, including guard or reserve duty, enter your military base, assignments, or unit of assignment. A separate block is used for each change of duty station and/or deployment.
•List ALL periods of unemployment in excess of 30 days. If more space is needed, continue your response on page 27.
•If you cannot locate the information, explain all efforts your have made to find it on page 27.
27.1
NAME OF CURRENT EMPLOYER OR MILITARY UNIT
ADDRESS (NUMBER / STREET / SUITE / OR BASE)
SUPERVISOR
EXT
JOB TITLE / RANK
DUTIES / ASSIGNMENTS
TYPE OF
EMPLOYMENT (CHECK ALL THAT APPLY)
FT
PT
Temp
Self-employed
Volunteer
NAMES OF CO-WORKERS AND PHONE NUMBER
REASON FOR WANTING TO LEAVE
1)
2)
Is there any reason this employer may make negative statements about you if contacted?
IF YES, explain:
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