Knowing the ins and outs of any process can be daunting, without even considering the step-by-step paperwork. PD 107 A Form is no exception - from insurance claims to pension applications, completing a form correctly is key to making sure you get what you need. That's why today we're breaking down exactly how to complete your PD 107A Form with ease - in this comprehensive guide are all the detailed instructions and information that you'll need for getting it right first time. Ready? Let's dive right in!
| 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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worked per week: |
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Employer: |
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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 |
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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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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 |