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 W4 Form
  2. 18-19 FSA Enrollment Form- Wayne County
  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. FMLA Form
  16. FMLA Family Member
  17. FMLA Military
  18. FMLA Military Family
  19. FMLA Veteran Caregiver
  20. FMLA Designation Notice
  21. FMLA Rights and Responsibilities
  22. Full-Time Orientation Checklist (DOC)
  23. Goal Setting Work Plan (DOC)
  24. Leave Without Pay Request (DOC)
  25. NC Retirement Beneficiary Form
  26. NC State Tax Form (PDF)
  27. Non Exempt Employee Acknowledgement Form (PDF)
  28. Opt Out BCBS 2018-19
  29. Payroll Deduction Authorization Form - Life Insurance (DOC)
  30. Payroll Deduction Authorization Form BCBS HSA (DOC)
  31. Payroll Deduction Authorization Form BCBS PPO (DOC)
  32. Probationary Progress Report (PDF)
  33. Prudential One-Time Contribution Form (PDF)
  34. Regular Part Time Employee New Hire checklist
  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 Assistant Application Form (DOC)
  43. Tuition Assistance Program Refund Request
  44. Volunteer Request Form (DOC)
  45. Wayne County Application Form (PDF)
  46. Wayne County Personnel Policy Acknowledgement (PDF)
  47. Wayne County Property Tax Deduction Form (PDF)
  48. Workers Compensation Reporting Package 2019
  49. Exempt Employee Acknowledgement Form (PDF)