Fill and Sign the Judicial Branch of Government Application for Work or Employment Continuation Page North Carolina Form

CONTINUATION SHEET — APPLICATION FOR EMPLOYMENT — JUDICIAL BRANCH OF GOVERNMENT Social Security Number (last four digits only)      Last Name Employer Address Job Title Supervisor’s Name Telephone No. ( ) - No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per Ending Salary $ per Reason for Leaving May We Contact Employer? YES NO Date Separated (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in the order of their importance in the job : Employer Address Job Title Supervisor’s Name Telephone No. ( ) - No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per Ending Salary $ per Reason for Leaving May We Contact Employer? YES NO Date Separated (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in the order of their importance in the job : Employer Address Job Title Supervisor’s Name Telephone No. ( ) - No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per Ending Salary $ per Reason for Leaving May We Contact Employer? YES NO Date Separat e d (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in the order of their importance in the job : 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, false 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 shall be mandatory if fraudulent information is given given to meet position qualifications (Authority: G.S. 126-30, G.S. 14-122.1) I understand that Judicial Branch employees are not subject to the State Personnel Act. Judicial Branch employees serve “at the pleasure” of their hiring authorities. This means that employment may be terminated with or without cause and/or advance notice by either the employer or the employee. However, termination by the employer may not occur due to discrimination prohibited by law. If I am employed by an independent hiring authority within the Judicial Branch of Government, such as a judge, clerk of superior court, district attorney or public defender, I understand that I will serve at the pleasure of that official, that my employment may be terminated by that official without cause or notice, neither I nor the judicial official by whom I am employed is an employee of the Administrative Office of the Courts, and that the Administrative Office of the Courts has no authority over the hiring decisions or other employment practices of the judicial official by whom I am employed. DO NOT SIGN BEFORE CAREFULLY READING THIS SECTION Signature of Applicant (unsigned application will not be processed) Date AOC-A-133, Page Two, Rev. 11/05  2005 Administrative Office of the Courts An Equal Opportunity Employer CONTINUATION SHEET — APPLICATION FOR EMPLOYMENT —JUDICIAL BRANCH OF GOVERNMENT Social Security Number (last four digits only)      Last Name Employer Address Job Title Supervisor’s Name Telephone No. ( ) - No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per EndingSalary $ per Reason for Leaving May We Contact Employer? YES NO Date Separated (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in the order of their importance in the job : Employer Address Job Title Supervisor’s Name Telephone No. ( ) - No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per Ending Salary $ per Reason for Leaving May We Contact Employer? YES NO Date Separated (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in the order of their importance in the job : Employer Address Job Title Supervisor’s Name Telephone No. ( ) - No. Supervised by You: Date Employed (mo/yr) Starting Salary $ per Ending Salary $ per Reason for Leaving May We Contact Employer? YES NO Date Separated (mo/yr) Full Time Years Months Part Time Years Months If part time, no. hours per week: List major duties in the order of their importance in the job : 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, false 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 shall be mandatory if fraudulent information is given to meet position qualifications (Authority: G.S. 126-30, G.S. 14-122.1) I understand that Judicial Branch employees are not subject to the State Personnel Act. Judicial Branch employees serve “at the pleasure” of their hiring authorities. This means that employment may be terminated with or without cause and/or advance notice by either the employer or the employee. However, termination by the employer may not occur due to discrimination prohibited by law. If I am employed by an independent hiring authority within the Judicial Branch of Government, such as a judge, clerk of superior court, district attorney or public defender, I understand that I will serve at the pleasure of that official, that my employment may be terminated by that official without cause or notice, neither I nor the judicial official by whom I am employed is an employee of the Administrative Office of the Courts, and that the Administrative Office of the Courts has no authority over the hiring decisions or other employment practices of the judicial official by whom I am employed. DO NOT SIGN BEFORE CAREFULLY READING THIS SECTION Signature of Applicant (unsigned application will not be processed) Date AOC-A-133, Page Two, Side Two, Rev. 11/05)  2005 Administrative Office of the Courts An Equal Opportunity Employer