Additional Jobs

Continuation Sheet -- Application for Employment based on PD 107 A (Rev 04/2006)
McDowell County
Last 4 digits of Social Security No.
Last Name
Employer
Address
Job Title
Supervisor’s Name
Telephone number
Format: (000) 000-0000.
No. Supervised by you
Date Employed (mo/yr)

MonthDayYear
Date
Reason for Leaving
Starting Salary
Per (ex: hour, year, week)
Ending Salary
Per (ex: hour, year, week)
Date Separated (mo/yr)

MonthDayYear
Date
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
- Phone Number
  Format: (000) 000-0000.
- No. Supervised by you
- Date Employed (mo/yr)
  
  MonthDayYear
  Date
- Reason for Leaving
- Starting Salary
- Per (ex: hour, annual, week)
- Ending Salary
- Per (ex: hour, annual, week)
- Date Separated (mo/yr)
  
  MonthDayYear
  Date
- 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
  Format: (000) 000-0000.
- No. Supervised by you
- Date Employed (mo/yr)
  
  MonthDayYear
  Date
- Reason for Leaving
- Starting Salary
- Per (ex: hour, annual, week)
- Ending Salary
- Per (ex: hour, annual, week)
- Date Separated (mo/yr)
  
  MonthDayYear
  Date
- 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:

McDowell County