N.C. Department of Health and Human Services
New Employee Orientation
New Employees
Menu Bar
Completing Forms
Instructions
Day 1
Forms
Policy
State Health Plan
First 30 Days
Resources
 
Previous
Progress Bar Begining
Next

Acknowledgement of Responsibility for Repayment of Monies Owed

Why do I need to fill out this form?

You need to sign this form in case you are overpaid and leave your job in the future before making repayment. The form gives the department permission to withhold some of your final pay if necessary.


* .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.


Previous
Progress Bar Begining
Next
Instructions :: Day 1 :: First 30 Days :: Resources
Main Page State Employees' Credit Union NC Office of State Personnel NC Government