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