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BENEFITS Top |
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Accidental Death & Dismemberment  |
Reliance AD&D Enrollment Card (Effective 1/1/08) |
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Reliance AD&D Request for Change |
| Affidavit for Domestic Partner Coverage |
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Dental |
Assurant* Dental Application (Domestic Partner coverage available 1/1/08) |
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Assurant* Dental Change Request |
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Assurant* Dental Claim Form |
| Affidavit for Domestic Partner Coverage |
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Disability |
Liberty Mutual Supplemental Disability Enrollment Form |
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Liberty Mutual Evidence of Insurability – Late Entrant |
| Liberty Mutual Long Term Disability Claim Form |
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The Standard Long Term Disability Enrollment and Change Form |
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The Standard Medical History Statement |
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The Standard Long Term Disability Claim Form |
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Health |
Enrollment Application (PPO & Indemnity Plan) |
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Health Insurance Portability and Accountability Act (HIPPA) Authorization |
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State Health Plan Change Form |
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State Health Plan Claim Form |
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Prescription Drug Claim Form |
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Life Insurance |
Affidavit for Domestic Partner Coverage |
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Met Life Enrollment/Change Form |
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Met Life Change of Beneficiary Form |
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Met Life Statement of Health |
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NC Flex |
Accidental Death & Dismemberment (AD&D) Beneficiary Designation Form |
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Accidental Death & Dismemberment (AD&D) Portability and Conversion Form |
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Dental Claim Form |
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Enrollment Form |
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Health Care & Dependent Care Spending Account Request for Reimbursement |
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Health Insurance Portability and Accountability Act(HIPA)Privacy Authorization Form |
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Status Change Form |
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Retirement |
Authorization Agreement for Direct Deposit - Required |
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ORP 1 - Optional Retirement Plan Enrollment Form |
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ORP 2 - Optional Retirement Plan Change Form |
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ORP 3 - Optional Retirement Plan Acknowledgment for Disposition of Account Contributions |
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ORP 4 - Optional Retirement Plan Authorization for Coverage Under the State of NC Retired Group Health Plan |
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Retirement Plan Election Form |
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Form 2C - Designating Beneficiary(ies) for Retirement System Contributions and the Death Benefit |
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Form 5 - Withdrawing Your Retirement Service Credit and Contributions |
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Form 6 - Claiming Your Monthly Retirement Benefit |
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Form HM - Selecting Health Coverage Through the State Health Plan |
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TIAA CREF Notice of Change of Name |
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401K |
NC 401K Plan Prudential Retirement |
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NC 401K One Time Deferral Rate Change Form |
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403(b) |
The University of North Carolina Authorization for 403 (b) Salary Reduction Agreement |
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457 |
State of NC Deferred Compensation Program Enrollment Form |
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Tuition Waiver |
Application for Faculty/Staff Waiver |
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Worker’s Compensation |
Employee Statement and Leave Options |
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North Carolina Industrial Commission Employer's Report of Injury to Employee |
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CLASSIFICATION & COMPENSATION Top |
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109 - Employee Status Change/Compensation Action |
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EPA or SPA Position Description Form |
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EMPLOYMENT Top |
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Request for Approval of Secondary Employment |
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Teleworking Agreement - Pilot Program |
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LEAVE Top |
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Adverse Weather Make-up Time Agreement |
| FMLA Certification of Health Care Provider |
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Request for Leave (including Leave Without Pay) |
| 113 - Voluntary Shared Leave Donation |
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114 - Voluntary Shared Leave Application |
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PAYROLL Top |
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Change of Address Form |
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Direct Payroll Deposit Authorization Form |
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Direct Deposit Cancellation Form |
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Employment Eligibility Verification (I-9) |
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Withholding Allowance Certificate (W-4) |
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Withholding Allowance Certificate (NC-4) |
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PERFORMANCE MANAGEMENT Top |
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Interim Review |
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RECRUITMENT & STAFFING Top |
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108 - New Hire Employment Information |
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109 - Employee Status Change/Compensation Action |
| 111 - Employee Profile Form |
| Permissible & Impermissible Interview Questions |
| SPA Samples of Non-Selection Letters |
| Verification of Creditable Service |
| Sample SPA Employee Appointment Confirmation Letter |
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Reference Check |
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SEPARATING EMPLOYMENT Top |
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115- Separation from Employment |
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TRAINING & DEVELOPMENT Top |
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Academic Assistance Form |
