N.C. Department of Health and Human Services
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State Health Plan
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Creditable Service Form

Why do I need to fill out this form?

You should complete this form to indicate whether or not you have prior state, local service, or both to credit to your total years of service. If not, you will just indicate that you have no past creditable service time and sign the form. If so, completing this form enables your Human Resources office to verify your prior service and ensure you are properly credited for the time. Any prior creditable service provides credit toward your vacation, longevity, and service awards. In addition, your vacation, sick leave, or both may be transferable.

To download the form for your signature, click below. If you have past "creditable service" click below to download the form.

Download the Employee Certification of Total State Service form (.PDF)*

If you are not sure if your past employment will count as "creditable service", see the lists below.

What counts as creditable service?

    • Permanent employment with any NC state agency (20 hours or more per week)
    • Public School System of NC
    • Administrative Office of the Courts
    • Social Services, Mental Health and Public Health (no credit for Wake County after 12/96)
    • County Agriculture Extension Service/Cooperative Extension Service.

What does NOT count as creditable service?

    • Service in other states
    • Federal employment
    • City employment
    • County employment
    • Sheriff's or local police department
    • Temporary Services (except General Assembly employees)
    • Time while out on "Leave Without Pay"

* .PDF refers to Portable Document Format, which is a readable format for many types of web documents. If you do not have Adobe Acrobat Reader installed on your computer, you will not be able to see the form. Acrobat Reader is free and available at the Adobe website:

Acrobat Reader Get Adobe Acrobat Reader

Click here to return to the Forms List page.

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