Human Resources

Department Head Assistance

On-line Benefit Forms

Blue Cross Blue Shield of North Carolina

Health: Blue Options
Dental: Dental Blue
To download forms in Acrobat Reader, click on the links below:
Enrollment/Change Form
Medical Reimbursement Claim Form
Prescription Drugs Reimbursement Claim Form
Dental Reimbursement Claim Form

Retirement

North Carolina Local Governmental Employees' Retirement System
North Caorlina Local Governmental Law Enforcement Officers' Retirement System
To download forms in Acrobat Reader, click on the links below:
Enrollment Form
Change of Beneficiary, Address or Personal Information
Application for Refund

Deferred Compensation
401(k )/ 457(b) Payroll Deduction Change Form (Word format)

Direct Deposit

North Carolina (NC-4) Tax Withholding Form

Federal (W-4) Tax Witholding Form
Henderson County Change of Address Form
Henderson County Flex Spending Account Enrollment Form
   

 

Employment Forms

Henderson County Application

Employee Reference Form

Drug Screen Consent Form

Driver's History Release Form

I-9 Form (Acrobat Reader Format)

W-4 Withholding Tax Form

NC-4 Withholding Tax Form

FMLA Request Form

FMLA Certification by Physician of Employee's Serious Health Condition

FMLA Certification by Physician of a Family Member's Serious Health Condition

Shared Leave Request Form

Workplace Threat Response Event Form

 

Other Useful Forms (in Word Format)

Automobile Accident Report Form

Citizen Incident Report Form

Property Damage Report Form

Nonexempt Employee Timesheet

Travel Reimbursement Form (in Excel Format)

Please feel free to contact the Human Resources Department (697-4669) if you need further assistance.


HCHRD Home Page

 

This server makes some Henderson County Human Resources Department information available to our fellow HR professionals. This project is ongoing, with more being added to this page on a continuing basis. Please send any suggestions or report any problems to: Mary Alice Jackson.