The PD 107 A form, often encountered by individuals seeking employment within the State of North Carolina, serves as a vital continuation sheet that complements the standard Application for Employment. With a revision date of June 2009, this document is crucial for those who need to provide comprehensive details about their employment history. It not only asks for basic information such as the last four digits of the Social Security Number, full name, and details of past employers but also delves into the specifics of each employment instance. Candidates are required to list job titles, the names of their supervisors, contact numbers, and the number of individuals they may have supervised. Moreover, the form neatly segments employment periods into full-time and part-time experiences, prompting for the start and end dates, salaries, reasons for leaving, and importantly, the significant duties performed that align with the competencies required for the new position being applied for. This focus on detailed work history not only aids in painting a comprehensive picture of the applicant’s professional journey but also highlights the development of skills over time. Additionally, the form includes a declaration where the applicant certifies the truthfulness of the information provided, acknowledging the potential for verification and the consequences of falsification. This clause emphasizes the form's role in ensuring integrity and accuracy in the application process, encapsulating its importance beyond merely collecting employment data.
| Question | Answer |
|---|---|
| Form Name | Pd 107 A Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | pd107a pd 107 fillable continuance form |
PD 107 A (Rev 06/2009) Continuation Sheet
STATE OF NORTH CAROLINA
An Equal Opportunity/Affirmative Action Employer
Last 4 digits of Social Security No.
Last Name
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Job Title: |
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Supervisor’s Name |
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No. Supervised by you: |
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Date Employed (mo/yr) |
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Starting Salary |
Ending Salary |
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Date Separated (mo/yr) |
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importance in the job: |
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Part Time |
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If part time, number of hours |
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worked per week: |
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Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name |
Telephone Number |
No. Supervised by you: |
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Date Employed (mo/yr) |
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Starting Salary |
Ending or Current Salary |
Reason for Leaving |
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$ |
per |
$ |
per |
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Date Separated (mo/yr) |
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List major duties that demonstrate your competencies related to the position for which you are applying in order of their |
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importance in the job: |
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Full Time |
Years |
Months |
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Part Time |
Years |
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If part time, number of hours |
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worked per week: |
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Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name |
Telephone Number |
No. Supervised by you: |
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Date Employed (mo/yr) |
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Starting Salary |
Ending or Current Salary |
Reason for Leaving |
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$ |
per |
$ |
per |
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Date Separated (mo/yr) |
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List major duties that demonstrate your competencies related to the position for which you are applying in order of their |
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importance in the job: |
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Full Time |
Years |
Months |
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Part Time |
Years |
Months |
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If part time, number of hours |
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worked per week: |
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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.
Signature of Applicant (unsigned applications will not be processed) |
Date |