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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
- 2019 W4 Form
- 18-19 FSA Enrollment Form- Wayne County
- ACA Credible Coverage
- AFLAC CI Enrollment Form (PDF)
- AFLAC HI Enrollment Form (PDF)
- Ameritas Dental Enrollment and Change Application (PDF)
- AMERITAS Dental Plan Prices 2018
- AUL Enrollment Form (PDF)
- BCBS Enrollment and Change Application (PDF)
- BCBS Plan Prices 2018-2019
- BCBS Web Access (PDF)
- Contacts for Change of Name and Address (DOC)
- Direct Deposit Form
- Employee Information Sheet (PDF)
- FMLA Form
- FMLA Family Member
- FMLA Military
- FMLA Military Family
- FMLA Veteran Caregiver
- FMLA Designation Notice
- FMLA Rights and Responsibilities
- Full-Time Orientation Checklist (DOC)
- Goal Setting Work Plan (DOC)
- Leave Without Pay Request (DOC)
- NC Retirement Beneficiary Form
- NC State Tax Form (PDF)
- Non Exempt Employee Acknowledgement Form (PDF)
- Opt Out BCBS 2018-19
- Payroll Deduction Authorization Form - Life Insurance (DOC)
- Payroll Deduction Authorization Form BCBS HSA (DOC)
- Payroll Deduction Authorization Form BCBS PPO (DOC)
- Probationary Progress Report (PDF)
- Prudential One-Time Contribution Form (PDF)
- Regular Part Time Employee New Hire checklist
- Retirement Law Enforcement (PDF)
- Retirement Local Government (PDF)
- Sick Leave Sharing Form
- Standard Life Insurance Additional Coverage Costs (PDF)
- Standard Life Insurance Policy (PDF)
- Standard Term Life Enrollment Form - Wayne County
- Superior Vision Enrollment and Change Form (DOC)
- Tuition Assistant Application Form (DOC)
- Tuition Assistance Program Refund Request
- Volunteer Request Form (DOC)
- Wayne County Application Form (PDF)
- Wayne County Personnel Policy Acknowledgement (PDF)
- Wayne County Property Tax Deduction Form (PDF)
- Workers Compensation Reporting Package 2019
- Exempt Employee Acknowledgement Form (PDF)
Benefits
- 401K (DOC)
- 401K And 457 Program Details and Application Form (PDF)
- Administrative Leave Form (DOC)
- Bereavement Leave (DOC)
- Civil Leave Form (DOC)
- Educational Leave (DOC)
- Flexible Benefits (DOC)
- Longevity Pay (DOC)
- Medical Insurance (DOC)
- Military Leave (DOC)
- Near Miss No Injury Investigation Form (DOC)
- Non Family Medical Leave Form (DOC)
- Retirement Benefits (DOC)
- Sick Leave and Family Medical Leave Form (DOC)
- Term Life Insurance (DOC)
- Training Form (DOC)
- Vacation Leave Form (DOC)
- Volunteerism (DOC)
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Contact Us
Mark III Phone: 800-532-1044 x 207
Ray Brown
Colonial Insurance
Phone: 919-778-9404