Form Pd 107 PDF Details

Form pd 107 is an important document for both taxpayers and the Internal Revenue Service. The form is used to report any changes in a person's tax situation, as well as to request additional time to file taxes. Knowing when and how to use this form can help taxpayers avoid penalties and stay in compliance with IRS regulations. This blog post will discuss the basics of Form Pd 107, including when it should be used and what types of changes it covers.

You may find info about the type of form you intend to submit in the table. It will show you the length of time you will need to complete form pd 107, what fields you will need to fill in and some further specific details.

QuestionAnswer
Form NameForm Pd 107
Form Length3 pages
Fillable?Yes
Fillable fields144
Avg. time to fill out29 min 37 sec
Other namesnc application for employment, pd 107 state application, pd 107 application nc, pd 107

Form Preview Example

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

NO

Notification Date:

 

 

 

 

 

 

 

 

Service registration, certify

 

YES NO

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

 

YES

 

NO

 

 

 

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

 

NO

 

 

 

 

 

 

 

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

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entered:

 

 

Separated:

 

 

 

 

 

Branch:

 

 

 

 

 

 

 

 

Rank

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENCY USE ONLY: ELIGIBILITY FOR VETERAN’S PREFERENCE:

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHECK the types of work you will accept:

1.

Permanent full-time

 

2. Permanent part-time

3.

Temporary full-time

 

4. Temporary part-time

 

 

 

 

 

 

 

 

5.

Any of the preceding

6.

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.)

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

 

 

2.

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

College(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

University (s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Graduate or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other educational,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

vocational school,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

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