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Frequently Requested Benefit Forms

 

TIMESHEET Non-exempt Timesheet Timesheet Presentation
Accident Policy (Assurity) Accident Claim Form
BCBS - Medical and Dental Insurance BCBS Enrollment/Change Form Health Plan Comparison
BCBS Medical Claim Form BCBS Dental Claim Form
Cancer Policy (Assurity) Cancer Screening Claim Form Cancer Claim Form
Deferred Compensation - 401(k) and 457(b) 401(k) and 457(b) County Enrollment Form
401(k) Enrollment Form 401(k) Beneficiary Form
457(b) Enrollment Form 457(b) Beneficiary Change Form
Employee Assistance Network EAN Brochure What is EAN?
EAN On-line

 

Family Medical Leave

 FMLA Policy (effective 04/01/12) Highlights of FMLA Changes Effective 04/01/12
FMLA Leave Request Form DOL FMLA Poster
Supervisor's Quick Reference Guide to FMLA
Flexible Spending Accounts Health Care Reimbursement Form Dependent Care Reimbursement Form
Transaction Substantiation Form
Health Savings Account HSA Authorization Form
Legal Notice Booklet
MetLife Life Insurance Election Card Statement of Health
Beneficiary Change Form
Standard Short-term Disability Claim Form
Tax Withholding Forms W4 Federal NC 4 State
"Wellness Matters" Wellness Program Website Health Risk Assessment Form
ADDITIONAL INFORMATION AND FORMS
Bereavement Policy Change of Address Direct Deposit
EEO Grievance Form Emergency Contact Information Employee Assistance Network
Employee Handbook General/Special Leave Request Form Munis Employee Self Service Instructions
Outside Employment Form New Employee Orientation Handbook Performance Appraisal Form
Shared Leave Form Vacation Leave Earnings Rate Wellness Clinic (map to clinic)
RISK MANAGEMENT FORMS
Automobile Accident Report Form Citizen Incident Form Employee Injury Incident Form

This server makes some Henderson County Human Resources Department information available to the public. 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.