Nc Pd 107 Form PDF Details

The PD 107 form, revised in February 2020, serves as the initial step for individuals seeking employment with the State of North Carolina, outlining a comprehensive process to ensure a fair and thorough evaluation of each candidate's fit for state government positions. It mandates the provision of detailed personal information, educational background, work history, and professional qualifications, alongside specific segments dedicated to ensuring equal employment opportunities without discrimination based on race, sex, color, creed, national origin, age, genetic information, or disability. Additionally, compliance with military selective service registration as required by G.S. 143b-421.1 is necessary for eligibility. Applicants are advised to submit a separate application for each job vacancy they're interested in, provide extensive details of their qualifications—including competencies and work behavior—relevant to the position they're applying for, and accurately provide their social security number's last four digits for verification purposes. Sections focusing on veteran status, availability preferences, and the types of work positions sought are included to tailor the employment matching process to individual circumstances and preferences. One notable directive is for candidates to avoid citing their resume in lieu of completing the form’s sections, emphasizing the importance of direct, detailed responses within the provided structure. Furthermore, the form incorporates a statement on the falsification of information that could result in rejection, disciplinary action, or dismissal if hired, underscoring the seriousness with which the information is reviewed. In essence, the PD 107 form acts as a critical gateway for aspirants to state employment in North Carolina, emphasizing transparency, equal opportunity, and the precise alignment of applicants’ skills and experiences with job requirements.

QuestionAnswer
Form NameNc Pd 107 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesstate north carolina application employment, employment nc application, state north carolina employment application, nc employment application

Form Preview Example

PD 107 (REV Feb 2020)

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, ifneeded.

•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.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you now work

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

 

 

 

If subject to Military Selective

 

 

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 forthe 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 localoffice:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dates Attended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Degree

 

 

Schools

Name and Location

 

(mo./yr.) From:

To:

 

 

 

Grad?

 

S/Q Hrs.

Major/Minor Course Work

Received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

High School

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 ContactEmployer

 

 

 

 

 

 

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 Nc Pd 107 Form Online for Free

By using the online tool for PDF editing by FormsPal, you are able to fill in or modify north carolina state employment application right here and now. In order to make our tool better and less complicated to use, we constantly come up with new features, taking into account feedback coming from our users. All it takes is several easy steps:

Step 1: Just click on the "Get Form Button" at the top of this webpage to get into our form editing tool. There you will find everything that is required to work with your file.

Step 2: After you start the file editor, you will see the form prepared to be completed. Apart from filling in various fields, you could also perform some other things with the Document, including writing any text, modifying the initial text, inserting images, signing the PDF, and a lot more.

It's easy to fill out the form using this practical guide! Here is what you must do:

1. Whenever completing the north carolina state employment application, make sure to include all important blank fields in its corresponding section. It will help speed up the work, allowing your information to be processed without delay and accurately.

Writing part 1 of employment application north carolina

2. Just after the previous part is done, proceed to enter the relevant details in all these - 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, and Email Address.

Filling in section 2 of employment application north carolina

3. The following section is all about Job Applied For, Enter below the specific title and, Job Title, Vacancy Number, Referral Source, Please indicate your referral, If you were referred by NC, Education Circle highest grade, Under SQ Hrs list the hours of, Schools, High School, Colleges University s, Graduate or Professional, Other educational vocational, and Name and Location - type in all of these blank fields.

Completing segment 3 of employment application north carolina

4. The form's fourth subsection arrives with these particular empty form fields to enter your specifics in: Current professional status List, Registration, Registration, State, State, DO NOT COMPLETE THIS BLOCK, DEGREES AND PROFESSIONAL, Have been verified Will be, and Person Responsible.

Writing section 4 of employment application north carolina

People who use this document often make errors when completing Registration in this area. You should definitely review whatever you type in here.

5. Lastly, the following final section is precisely what you'll have to wrap up before finalizing the document. The blank fields in question include the following: 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.

Part no. 5 in filling out employment application north carolina

Step 3: Prior to addressing the next step, you should make sure that blanks were filled in the proper way. As soon as you believe it is all fine, click “Done." Sign up with FormsPal right now and immediately use north carolina state employment application, all set for downloading. All alterations made by you are kept , so that you can edit the file later on anytime. We don't share or sell any information you type in when completing documents at our website.

Nc Pd 107 Form isn’t the one you’re looking for?

Related Documents