PERSONNEL

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Essential Personnel

employment applications

• Employment Application

ncdor labor law

• English
• Spanish

policies

• Personnel Policy
• Public Forum Policy
• Social Media Policy
• Social Media Policy NEW
• Telecommuting Policy NEW
• Telework Policy NEW

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

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