Additional Jobs PD-107

Continuation Sheet -- Application for Employment based on PD 107 A (Rev 04/2006)
State of North Carolina

An Equal Opportunity/Affirmative Action Employer
Last 4 digits of Social Security No.
Last Name
Employer
Address
Job Title
Supervisor’s Name
Telephone number
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:

Additional Work History
Employer
Address
Job Title
Supervisor’s Name
Phone Number
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:

Additional Work History
Employer
Address
Job Title
Supervisor’s Name
Telephone Number
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:

State of North Carolina