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 Credible Coverage
  2. AFLAC CI Enrollment Form (PDF)
  3. AFLAC HI Enrollment Form (PDF)
  4. Ameritas Dental Enrollment and Change Application (PDF)
  5. AMERITAS Dental Plan Prices 2018
  6. AUL Enrollment Form (PDF)
  7. BCBS Enrollment and Change Application (PDF)
  8. BCBS Plan Prices 2018-2019
  9. BCBS Web Access (PDF)
  10. Opt Out BCBS 2018-19
  11. Contacts for Change of Name and Address (DOC)
  12. Direct Deposit Form
  13. Employee Information Sheet (PDF)
  14. Federal Tax W-4 2018
  15. FMLA Designation Notice (PDF)
  16. FMLA For Employees Serious Health Condition (PDF)
  17. FMLA Family Members Serious Health Condition (PDF)
  18. FMLA Military Caregiver Leave (PDF)
  19. FMLA For Military Leave (PDF)
  20. FMLA Notice of Eligibility and Rights and Responsibilities (PDF)
  21. FMLA Qualifying Exigency for Military Leave (PDF)
  22. FMLA Veterans Serious Health Condition or Injury
  23. 18-19 FSA Enrollment Form- Wayne County
  24. Full-Time Orientation Checklist (DOC)
  25. Goal Setting Work Plan (DOC)
  26. Immediate Care Authorization Form (PDF)
  27. Leave Without Pay Request (DOC)
  28. NC Retirement Beneficiary Form
  29. NC Tax Form NC4EZ 2018
  30. NC State Tax Form (PDF)
  31. Non Exempt Employee Acknowledgement Form (PDF)
  32. Payroll Deduction Authorization Form - Life Insurance (DOC)
  33. Payroll Deduction Authorization Form BCBS HSA (DOC)
  34. Payroll Deduction Authorization Form BCBS PPO (DOC)
  35. Probationary Progress Report (PDF)
  36. Prudential One-Time Contribution Form (PDF)
  37. Regular Part Time Employee New Hire checklist
  38. Retirement Law Enforcement (PDF)
  39. Retirement Local Government (PDF)
  40. Sick Leave Sharing Form
  41. Standard Life Insurance Additional Coverage Costs (PDF)
  42. Standard Life Insurance Policy (PDF)
  43. Standard Term Life Enrollment Form - Wayne County
  44. Superior Vision Enrollment and Change Form (DOC)
  45. Tuition Assistant Application Form (DOC)
  46. Tuition Assistance Program Refund Request
  47. Volunteer Request Form (DOC)
  48. Wayne County Application Form (PDF)
  49. Wayne County Personnel Policy Acknowledgement (PDF)
  50. Wayne County Property Tax Deduction Form (PDF)
  51. Exempt Employee Acknowledgement Form (PDF)
  52. WORKERS COMPENSATION REPORTING PACKAGE 2018

Benefits