Employment Application

Employment Application

 

NCDOR Labor Law

English

Spanish

 

Policies

Personnel Policy

 

Tax Forms

W-4 Form (Federal Tax Withholding)

NC-4 EZ Form (State Tax Withholding)

 

Direct Deposit

Direct Deposit Form

Direct Deposit FAQs

 

E-Verify Forms

Employment Eligibility Verification Form (I-9)

I-9 Instructions

I-9 Supplement

 

Family Medical Leave Act (FMLA)

WH-380-E  Certification of Health Care Provider for Employee’s Serious Health Condition

WH-380-F  Certification of Health Care Provider for Family Member’s Serious Health Condition

WH-381      Notice of Eligibility and Rights & Responsibilities

WH-382      Designation Notice

WH-384      Certification of Qualifying Exigency for Military Family Leave

WH-385      Certification for Serious Injury or Illness of a Current Service member

WH-385-V  Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave

 

Insurance Forms

Employee Benefit Synopsis

MedCost – Health Insurance  (1-800-217-5097)

• Change Form 040 MIT, MBS
• Cost Estimator Flyer
• Digital ID Card
• Enrollment Form 065 MDL, MIT, MBS
• M599 Town of Biscoe MED 3000 30-40 Schedule
• Member Account Flyer
• MIT Wellness Participation 2019-2020
• MIT Wellness Participation Checklist
• Naturally Slim Flyer
• PCM Healthier You NCLM
• SmartStarts Precious Gift NCLM
• Teladoc
• Trestle Tree

 

MetLife – Dental Insurance (1-800-275-4638)

• MetLife Change Term
• Metlife Dental Enrollment Form

 

AlwaysCare – Vision (1-888-729-5433)

• AlwaysCare Employee Change Form
• Always Care Enrollment Form

 

Transamerica - Life Insurance (1-888-763-7474)

• Application
• Request for Policy Service
• TransElite HFA Rates
• About TransElite

 

AFLAC – Supplemental Insurance (1-800-992-3522)

• Accident Insurance
• Cancer Insurance
• Critical Illness Insurance
• Life Insurance
• Hospital Insurance
• Short Term disability Insurance
• Dental Insurance
• Vision Insurance

 

USABLE - Short-term Disability, Long-term Disability, Accidental Death & Dismemberment (AD&D), Life Insurance - (1-800-370-5856)

 

Retirement Contacts

 

401k - Prudential Retirement

• Address and Name Change Form

• Beneficiary Designation Form
• Employer Change Form
• Enrollment Form
• Investment & GoalMaker Election and Contribution Change Form
• One Time Contribution Form
• Report of Termination/Request for Distribution Form
• Request for Hardship Form
• Request for Minimum Distribution Form
• Request for Systematic Disbursement Form
• Rollover Pre-Approval Form
• Service Credit Purchase Form
• Special Tax Notice

 

457b - Prudential Retirement

• Address and Name Change Form
• Beneficiary Designation Form
• Employer Change Form
• Enrollment Form
• Investment & GoalMaker Election and Contribution Change Form
• One Time Contribution Form
• Report of Termination/Request for Distribution Form
• Request for Minimum Distribution Form
• Request for Systematic Disbursement Form
• Request for Unforeseen Emergency Form
• Rollover Pre-Approval Form
• Service Credit Purchase Form
• Special Tax Notice
• Voluntary In-Service Disbursement Form

 

NC Local Government Retirement System

• NCLGRS Retirement Planning Video
• LEO Separation Allowance