Benefits & Forms

Wayne County prides itself on having a competitive, productive workforce. 

We offer excellent benefits, including:

  • 401(k) with matching criteria
  • Competitive vacation and sick leave
  • Full health benefits for eligible employees (medical, dental, and vision)
  • Training opportunities to keep skills current and marketable


Forms

  1. Non Exempt Employee Acknowledgement Form (PDF)
  2. Payroll Deduction Authorization Form BCBS HSA (DOC)
  3. Payroll Deduction Authorization Form BCBS PPO (DOC)
  4. Payroll Deduction Authorization Form - Dental (DOC)
  5. Payroll Deduction Authorization Form - Life Insurance (DOC)
  6. Probationary Progress Report (PDF)
  7. Prudential One-Time Contribution Form (PDF)
  8. Retirement Law Enforcement (PDF)
  9. Retirement Local Government (PDF)
  10. Retirement System Death Benefit Beneficiary Form (PDF)
  11. Retirement System Return of Contribution Form (PDF)
  12. Standard Life Insurance Additional Coverage Costs (PDF)
  13. Standard Life Insurance Policy (PDF)
  14. Superior Vision Enrollment and Change Form (DOC)
  15. Temporary Pharmacy Card Form (PDF)
  16. Volunteer Request Form (DOC)
  17. Wayne County Personnel Policy Acknowledgement (PDF)
  18. ACA Creditable Coverage (PDF)
  19. AFLAC CI Enrollment Form (PDF)
  20. AFLAC HI Enrollment Form (PDF)
  21. Ameritas Dental Enrollment and Change Application (PDF)
  22. Ameritas Dental Prices (PDF)
  23. AUL Enrollment Form (PDF)
  24. BCBS Enrollment and Change Application (PDF)
  25. BCBS Highlights for Traditional Plan PPO (PDF)
  26. BCBS Plan Prices (PDF)
  27. BCBS Web Access (PDF)
  28. FMLA Veterans Serious Health Condition or Injury
  29. Contacts for Change of Name and Address (DOC)
  30. Employee Change of Address or Name Form (DOC)
  31. Employee Information Sheet (PDF)
  32. Exempt Employee Acknowledgement Form (PDF)
  33. FMLA Designation Notice (PDF)
  34. FMLA Family Members Serious Health Condition (PDF)
  35. FMLA For Employees Serious Health Condition (PDF)
  36. FMLA For Military Leave (PDF)
  37. FMLA Military Caregiver Leave (PDF)
  38. FMLA Notice of Eligibility and Rights and Responsibilities (PDF)
  39. FMLA Qualifying Exigency for Military Leave (PDF)
  40. Full-Time Orientation Checklist (DOC)
  41. Goal Setting Work Plan (DOC)
  42. Immediate Care Authorization Form (PDF)
  43. Leave Without Pay Request (DOC)
  44. NC State Tax Form (PDF)
  45. Sick Leave Sharing Form
  46. Federal Tax W-4 2017
  47. Direct Deposit Form
  48. Wayne County Property Tax Deduction Form (PDF)
  49. Wayne County Application Form (PDF)
  50. Tuition Assistant Application Form (DOC)
  51. Opt Out BCBS 2016-17 (DOC)
  52. Part Time Employee New Hire checklist
  53. Regular Part Time Employee New Hire checklist
  54. Tuition Assistance Program Refund Request
  55. AdminUSA Enrollment and Change Form
  56. Standard Term Life Enrollment Form - Wayne County