Form Pd 107 – Fill Out and Use This PDF

The PD 107 form, revised in February 2020, serves as the official application for employment within the State of North Carolina. It's a comprehensive document that requires applicants to provide detailed information about their education, work history, and qualifications, ensuring that only the most suitable candidates are considered for state government employment. This process underscores the State's commitment to equal opportunity, necessitating that all sections are completed thoroughly to be eligible for consideration. For those interested in applying for a position within the North Carolina State Government, ensure you have accurately filled out the form by clicking the button below.

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Form Pd 107 PDF Details

The PD 107 form, revised in February 2020, serves as an essential document for those seeking employment with the State of North Carolina. To ensure consideration for a state government position, applicants are required to provide comprehensive and accurate information throughout the application, as incomplete applications may impede the employment process. The form mandates the inclusion of personal details, work eligibility status, such as U.S. citizenship or work authorization, compliance with military selective service registration for eligible males, and complete work and educational history. It stresses the importance of specifying competencies gained through previous job roles that align with the position applied for. Furthermore, the form includes sections on equal opportunity information to monitor the effectiveness of the state's recruitment efforts across various demographics, though providing ethnicity information remains optional. Applicants are also advised on the application’s privacy concerning social security numbers and are obligated to declare any criminal convictions, which do not automatically disqualify them from employment. The submission of this application signifies the applicant's consent for the verification of their provided information, which underscores the state's commitment to hiring qualified individuals while maintaining a rigorous verification process to ensure the integrity and fairness of the employment procedure.

Question	Answer
Form Name	Form Pd 107
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	pd 107 nc, nc state job application, pd 107 application nc, nc application for employment

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Revised Feb 2020

APPLICATION FOR EMPLOYMENT

State of North Carolina

INSTRUCTIONS:

To be considered for NC State Government employment, you must answer all questions (unless listed as optional) and complete all sections of this application form.

The State of North Carolina employs only US citizens or foreign nationals who can provide proof of identity and work authorization within 3 working days of employment. Males subject to military selective service registration must certify compliance to be eligible for state employment (G.S. 143b-421.1). See availability block.

When completing this application make sure you:

•Complete the equal opportunity information section.

•Apply for one vacancy per application.

•If you are a RIF applicant with priority- please check the appropriate box.

•Give complete information on your education and work history (“see resume” is not acceptable).

•List separately each job held and your duties for each position when you worked for one employer and held more than one position. Use a continuation sheet, PD 107-A, if needed.

•As you describe your work history, make sure you highlight your competencies (knowledge, skills, abilities and work behaviors) which demonstrate your qualifications for the position for which you are applying.

•Provide only the last four digits of your social security number.

•Check for accuracy, sign and date your application.

Thank you for your interest in employment with the State of North Carolina. North Carolina hires the most qualified people available to serve its citizens. Although everyone who applies cannot be hired, each application will be given consideration based on its competitiveness compared to other applications received. PD 107 (REV Feb 2020)

Equal Opportunity Information

State Government policy prohibits discrimination based on race, sex, color, creed, national origin, age, genetic information or disability. Sex, age or absence of disability is a bona fide occupational qualification in a small number of State jobs. The information requested below will not affect you as an applicant and is not forwarded to the hiring manager. Its sole use will be to see how well our recruitment efforts are reaching all segments of the population. Answering the ethnicity question is optional. Birth date is required for correct input by our technicians of paper application content into our electronic application system, where birthdate is required in order to save the application.

Ethnicity:

1.  White (Non-Hispanic/Latino)

2.Black or African American (Non-Hispanic/Latino)

3.Asian

4.American Indian or Alaskan Native

5.Native Hawaiian or Other Pacific Islander

6.Two or More Races (Non-Hispanic/Latino)

7.Hispanic/Latino

Birthdate (required):

Month__________ Day___ Year ______

Gender (required):

Male

Female

Disability:

Yes, I have a disability (or previously had a disability)

No, I don’t have a disability

I don’t wish to answer

Revised Feb 2020

APPLICATION FOR EMPLOYMENT

STATE OF

Date of Application

NORTH CAROLINA

Last 4 digits of Social Security No.

Last Name

First Name

Middle Name

Address (Street number and name)

City

County

State

Zip Code

Phone number where

you can be reached

Email Address

Availability

Are you a layoff candidate with the State of N.C. eligible for RIF priority reemployment

If subject to Military Selective

Do you now work

for the State of NC?

consideration as described by GS 126?

YES

Notification Date:

Service registration, certify

YES NO

Are you related by blood or marriage to any person now working for the State?

YES

compliance by initialing dotted line

If yes, give name, relationship to you and the agency where employed.

.......................................................

...............................

Military Service

Have you served honorably in the Armed Forces of the United States on active dutyfor reasons other than training?

YES

Do you wish to declare a service-connected disability? YES

At the time of this application, are you the surviving spouse or dependent of a deceased veteran who died from service-related reasons?

YES NO

Do you wish to declare eligibility for veteran’s preference asthe spouse of a disabled veteran? YES

Give dates of your (or spouse’s) qualifying active military service:

Entered:

Separated:

Branch:

Rank

AGENCY USE ONLY: ELIGIBILITY FOR VETERAN’S PREFERENCE:

YES

CHECK the types of work you will accept:

Permanent full-time

2. Permanent part-time

Temporary full-time

4. Temporary part-time

Any of the preceding

Work involving Travel

7. Shift or Split Shift Work

If you are not available for work now, enter the earliest date you could begin work (mo./day/yr.)

Will you accept work anywhere in N.C.?

YES

NO (If no, list below the counties in which you would be willing to work.)

Job Applied For

Enter below the specific title and vacancy number of the job for which you are applying.

Job Title:

Vacancy Number:

Referral Source

Please indicate your referral source:

If you were referred by NC Workforce Solutions please indicate which local office:

Education

Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12

GED College 1 2 3 4 Graduate School 1 2 3 4

Under S/Q Hrs., list the hours of credit received and if they were semester (S) or quarter (Q) hours.

Schools

Name and Location

Dates Attended

Grad?

S/Q Hrs.

Major/Minor Course Work

Type of Degree

(mo./yr.) From:

To:

Received

High School

YES

College(s)

YES

University (s)

Graduate or

YES

Professional

Other educational,

YES

vocational school,

internships, etc.

Special training programs and seminars you have completed in the last five years (list):

If the job(s) applied for calls for specific courses, indicate those courses taken and credits received:

Current professional status: (List fields of work for which you have been registered)

Registration:

State:

No.

Registration:

State:

No.

DO NOT COMPLETE THIS BLOCK

DEGREES AND PROFESSIONAL CREDENTIALS

Have been verified

Will be verified within 90 days (G.S. 126-30)

Person Responsible:

Revised Feb 2020

Other Licenses and certifications, including Driver License and State, if any (List, giving dates and sources of issuance):

Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and

how recently you were convicted will be evaluated in relation to the job for which you are applying.) YES NO (If yes, explain fully on an additional sheet.)

WORK HISTORY (include volunteer experience) Use additional sheets if necessary. As you describe your work history experiences, make sure you highlight your competencies which demonstrate your qualifications for the position for which you are applying.

Current or Last Employer:				Address:

Job Title:				Supervisor’s Name	Telephone Number:	No. Supervised by you:

Date Employed (mo./yr.)			Supervisor's e-mail:		Reason for Leaving	May We Contact Employer
						YES	NO

Date Separated (mo./yr.)			List major duties that demonstrate your competencies related to the position for which you are applying in order of their
			importance in the job:

Full Time	Years	Months

Part Time	Years	Months

If part time, number of hours
worked per week:

Employer:				Address:

Job Title:				Supervisor’s Name	Telephone Number	No. Supervised by you:

Date Employed (mo./yr.)			Supervisor's e-mail		Reason for Leaving

Date Separated (mo./yr.)			List major duties that demonstrate your competencies related to the position for which you are applying in order of their
			importance in the job:

Full Time	Years	Months

Part Time	Years	Months

If part time, number of hours
worked per week:

Employer:				Address:

Job Title:				Supervisor’s Name	Telephone Number	No. Supervised by you:

Date Employed (mo./yr.)			Supervisor's e-mail		Reason for Leaving

Date Separated (mo./yr.)			List major duties that demonstrate your competencies related to the position for which you are applying in order of their
			importance in the job:

Full Time	Years	Months

Part Time	Years	Months

If part time, number of hours worked per week:

I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S. 126-30, G.S. 14-122.1.)

Signature of Applicant (unsigned applications will not be processed)

Date

How to Edit Form Pd 107 Online for Free

Our PDF editor allows you to complete forms. It's not necessary to perform much to change pd 107 state application files. Simply check out the next actions.

Step 1: Choose the button "Get Form Here".

Step 2: The form editing page is now open. You can include text or manage present data.

The PDF file you wish to complete will contain the following areas:

Put the necessary data in the APPLICATION FOR EMPLOYMENT, STATE OF NORTH CAROLINA, Date of Application, Last digits of Social Security No, Last Name, First Name, Middle Name, Address Street number and name, City, County, State, Zip Code, Phone number where you can be, Email Address, and Availability Do you now work for box.

pd 107 nc APPLICATION FOR EMPLOYMENT, STATE OF NORTH CAROLINA, Date of Application, Last digits of Social Security No, Last Name, First Name, Middle Name, Address Street number and name, City, County, State, Zip Code, Phone number where you can be, Email Address, and Availability Do you now work for fields to insert

It is vital to provide certain particulars within the box If you are not available for work, Will you accept work anywhere in NC, YES NO If no list below the, Job Applied For Enter below the, Job Title, Vacancy Number, Referral Source, Please indicate your referral, If you were referred by NC, Education Circle highest grade, GED College Graduate School, Schools, Name and Location, Dates Attended, and moyr From.

You have to describe the rights and obligations of each side in space Current professional status List, Registration, Registration, State, State, DO NOT COMPLETE THIS BLOCK, DEGREES AND PROFESSIONAL, Have been verified Will be, and Person Responsible.

Fill in the form by analyzing these fields: Other Licenses and certifications, Have you ever been convicted of an, YES, WORK HISTORY include volunteer, Current or Last Employer, Address, Job Title, Supervisors Name, Telephone Number, No Supervised by you, Date Employed moyr, Supervisors email, Reason for Leaving, May We Contact Employer, and YES.

pd 107 nc Other Licenses and certifications, Have you ever been convicted of an, YES, WORK HISTORY include volunteer, Current or Last Employer, Address, Job Title, Supervisors Name, Telephone Number, No Supervised by you, Date Employed moyr, Supervisors email, Reason for Leaving, May We Contact Employer, and YES blanks to fill out

Step 3: Once you click on the Done button, the finalized file is conveniently transferable to any type of of your devices. Or, you may send it via mail.

Step 4: Be sure to stay clear of possible future troubles by preparing at least a couple of duplicates of your document.

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