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. 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. Full-Time Orientation Checklist (DOC)
  24. Goal Setting Work Plan (DOC)
  25. Leave Without Pay Request (DOC)
  26. MetLife Cancer-specified disease Claim Form
  27. NC Retirement Beneficiary Form
  28. NC State Tax Form (PDF)
  29. Non Exempt Employee Acknowledgement Form (PDF)
  30. Opt Out BCBS 2018-19
  31. Payroll Deduction Authorization Form - Life Insurance (DOC)
  32. Payroll Deduction Authorization Form BCBS HSA (DOC)
  33. Payroll Deduction Authorization Form BCBS PPO (DOC)
  34. Probationary Progress Report (PDF)
  35. Prudential One-Time Contribution Form (PDF)
  36. Regular Part Time Employee New Hire checklist
  37. Retirement Law Enforcement (PDF)
  38. Retirement Local Government (PDF)
  39. Sick Leave Sharing Form
  40. Standard Life Insurance Additional Coverage Costs (PDF)
  41. Standard Life Insurance Policy (PDF)
  42. Standard Term Life Enrollment Form - Wayne County
  43. Superior Vision Enrollment and Change Form (DOC)
  44. Tuition Assistance Application Form
  45. Tuition Assistance Program Refund Request
  46. Volunteer Request Form (DOC)
  47. Wayne County Application Form (PDF)
  48. Wayne County Personnel Policy Acknowledgement (PDF)
  49. Wayne County Property Tax Deduction Form (PDF)
  50. Workers Compensation Reporting Package 2019

Benefits