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. AdminUSA Enrollment and Change Form
  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. Contacts for Change of Name and Address (DOC)
  13. Direct Deposit Form
  14. Employee Change of Address or Name Form (DOC)
  15. Employee Information Sheet (PDF)
  16. Exempt Employee Acknowledgement Form (PDF)
  17. Federal Tax W-4 2017
  18. FMLA Designation Notice (PDF)
  19. FMLA For Employees Serious Health Condition (PDF)
  20. FMLA Family Members Serious Health Condition (PDF)
  21. FMLA Military Caregiver Leave (PDF)
  22. FMLA For Military Leave (PDF)
  23. FMLA Notice of Eligibility and Rights and Responsibilities (PDF)
  24. FMLA Qualifying Exigency for Military Leave (PDF)
  25. FMLA Veterans Serious Health Condition or Injury
  26. Full-Time Orientation Checklist (DOC)
  27. Goal Setting Work Plan (DOC)
  28. Immediate Care Authorization Form (PDF)
  29. Leave Without Pay Request (DOC)
  30. NC State Tax Form (PDF)
  31. Non Exempt Employee Acknowledgement Form (PDF)
  32. Opt Out BCBS 2016-17 (DOC)
  33. Part Time Employee New Hire checklist
  34. Payroll Deduction Authorization Form - Dental (DOC)
  35. Payroll Deduction Authorization Form - Life Insurance (DOC)
  36. Payroll Deduction Authorization Form BCBS HSA (DOC)
  37. Payroll Deduction Authorization Form BCBS PPO (DOC)
  38. Probationary Progress Report (PDF)
  39. Prudential One-Time Contribution Form (PDF)
  40. Regular Part Time Employee New Hire checklist
  41. Retirement Law Enforcement (PDF)
  42. Retirement Local Government (PDF)
  43. Retirement System Death Benefit Beneficiary Form (PDF)
  44. Retirement System Return of Contribution Form (PDF)
  45. Sick Leave Sharing Form
  46. Standard Life Insurance Additional Coverage Costs (PDF)
  47. Standard Life Insurance Policy (PDF)
  48. Standard Term Life Enrollment Form - Wayne County
  49. Superior Vision Enrollment and Change Form (DOC)
  50. Temporary Pharmacy Card Form (PDF)
  51. Tuition Assistant Application Form (DOC)
  52. Tuition Assistance Program Refund Request
  53. Volunteer Request Form (DOC)
  54. Wayne County Application Form (PDF)
  55. Wayne County Personnel Policy Acknowledgement (PDF)
  56. Wayne County Property Tax Deduction Form (PDF)