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


  1. 2019 Holiday Schedule
  2. 2020 Holiday Schedule.doc
  3. Wayne County Government Benefits Booklet 2019

Forms

  1. 2018-19 FSA Enrollment Form- Wayne County
  2. 2019 W4 Form
  3. ACA Credible Coverage
  4. AFLAC CI Enrollment Form (PDF)
  5. AFLAC HI Enrollment Form (PDF)
  6. Ameritas Dental Enrollment and Change Application (PDF)
  7. AMERITAS Dental Plan Prices 2018
  8. AUL Enrollment Form (PDF)
  9. BCBS Enrollment and Change Application (PDF)
  10. BCBS Plan Prices 2018-2019
  11. BCBS Web Access (PDF)
  12. Contacts for Change of Name and Address (DOC)
  13. Direct Deposit Form
  14. Employee Information Sheet (PDF)
  15. Exempt Employee Acknowledgement Form (PDF)
  16. FMLA Designation Notice
  17. FMLA Family Member
  18. FMLA Form
  19. FMLA Military
  20. FMLA Military - Family
  21. FMLA Rights and Responsibilities
  22. FMLA Veteran Caregiver
  23. Goal Setting Work Plan (DOC)
  24. Leave Without Pay Request (DOC)
  25. MetLife Cancer-specified disease Claim Form
  26. NC Retirement Beneficiary Form
  27. NC State Tax Form (PDF)
  28. Non Exempt Employee Acknowledgement Form (PDF)
  29. Opt Out BCBS 2018-19
  30. Payroll Deduction Authorization Form - Life Insurance (DOC)
  31. Payroll Deduction Authorization Form BCBS HSA (DOC)
  32. Payroll Deduction Authorization Form BCBS PPO (DOC)
  33. Probationary Progress Report (PDF)
  34. Prudential One-Time Contribution Form (PDF)
  35. Retirement Law Enforcement (PDF)
  36. Retirement Local Government (PDF)
  37. Sick Leave Sharing Form
  38. Standard Life Insurance Additional Coverage Costs (PDF)
  39. Standard Life Insurance Policy (PDF)
  40. Standard Term Life Enrollment Form - Wayne County
  41. Superior Vision Enrollment and Change Form (DOC)
  42. Tuition Assistance Application Form
  43. Tuition Assistance Program Refund Request
  44. Volunteer Request Form (DOC)
  45. Wayne County Application Form (PDF)
  46. Wayne County Property Tax Deduction Form (PDF)

Benefits

  1. 401K (DOC)
  2. 401K And 457 Program Details and Application Form (PDF)
  3. Administrative Leave Form (DOC)
  4. Bereavement Leave (DOC)
  5. Civil Leave Form (DOC)
  6. Educational Leave (DOC)
  7. Flexible Benefits (DOC)
  8. Longevity Pay (DOC)
  9. Medical Insurance (DOC)
  10. Military Leave (DOC)
  11. Near Miss No Injury Investigation Form (DOC)
  12. Non Family Medical Leave Form (DOC)
  13. Retirement Benefits (DOC)
  14. Sick Leave and Family Medical Leave Form (DOC)
  15. Term Life Insurance (DOC)
  16. Training Form (DOC)
  17. Vacation Leave Form (DOC)
  18. Volunteerism (DOC)

Worker’s Compensation Packet