Wage & Hour Bureau
1101 Mail Service Center
Raleigh, NC 27699-1101
SURETY BOND
Private Personnel Service
This bond is issued and submitted to the North Carolina Department of Labor pursuant to the provisions of North Carolina
General Statute §95-47.2(j).
We, the undersigned PRIVATE PERSONNEL SERVICE and Surety Company, duly authorized to transact business in the
State of North Carolina, do hereby obligate ourselves to the State of North Carolina in the amount of Ten Thousand
Dollars ($10,000.00) to be void upon the condition that the undersigned PRIVATE PERSONNEL SERVICE will pay to
applicants all refunds due under the provisions of Article 5A , of Chapter 95 of the General Statutes of North Carolina, and
regulations adopted thereunder, if the said private personnel service terminates its business operations in the State of
North Carolina.
BOND No.:
_____________________________________________
Name of Private Personnel Service
Effective Date:
_____________________________________________
Location:
Private Personnel Service’s Authorized Signature
_____________________________________________
Name of Surety Company
_____________________________________________
Surety Company’s Authorized Signature
SURETY COMPANY’S
OFFICIAL SEAL
Wage & Hour Bureau
1101 Mail Service Center
Raleigh, NC 27699-1101
SURETY BOND
Private Personnel Service
This bond is issued and submitted to the North Carolina Department of Labor pursuant to the provisions of North Carolina
General Statute §95-47.2(j).
We, the undersigned PRIVATE PERSONNEL SERVICE and Surety Company, duly authorized to transact business in the
State of North Carolina, do hereby obligate ourselves to the State of North Carolina in the amount of Ten Thousand
Dollars ($10,000.00) to be void upon the condition that the undersigned PRIVATE PERSONNEL SERVICE will pay to
applicants all refunds due under the provisions of Article 5A , of Chapter 95 of the General Statutes of North Carolina, and
regulations adopted thereunder, if the said private personnel service terminates its business operations in the State of
North Carolina.
BOND No.:
_____________________________________________
Name of Private Personnel Service
Effective Date:
_____________________________________________
Location:
Private Personnel Service’s Authorized Signature
_____________________________________________
Name of Surety Company
_____________________________________________
Surety Company’s Authorized Signature
SURETY COMPANY’S
OFFICIAL SEAL
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