NC STATE University Brick Logo
NC State Human Resources Department Header
Divider Bar Fade
Benefits
Address Change/Benefit Plans
 Change my Address Form

Electronic address change form for Benefits plans, employee must log into form with Unity Account User ID and password

  Form is External to Site
Award Nomination Forms
 Larkins, John R. Award Nomination Form

  Form is External to Site
Contact Benefits For Form
 College Savings Plan

   
Disability Plans
 Liberty Mutual Cancellation Form

For employees to terminate coverage with Liberty Mutual

PDF Document Icon  
 Liberty Mutual Change Form

For employees to change name or address with Liberty Mutual

PDF Document Icon  
 Liberty Mutual Enrollment Form

To enroll in the Liberty Mutual Plan

PDF Document Icon  
 Liberty Mutual Statement of Health Form

Statement of health questions for employees to enroll in Liberty Mutual during the year and annual enrollment

PDF Document Icon  
 Standard Long Term Disability Enrollment Form

To enroll in the Standard Insurance Plan

PDF Document Icon  
 Standard Long Term Disability Medical History Statement

Statement of health questions for employees to enroll in the Standard Insurance during the year

PDF Document Icon  
Health Insurance
 Other State Health Plan Forms

State Health Plan Forms such as authorization, reimbursement, prescription drug order

  Form is External to Site
 Post doc Health Insurance Enrollment Form for Foreign Nationals

Word Document Icon    
 Post-doc Health Insurance Enrollment Form for U.S. Citizens/U.S. Permanent Residents

For Post Doc's to enroll in the Post Doc Health Insurance

Word Document Icon    
 State Health Plan - SmartChoice PPO Change Form

To make coverage changes on the State Health Plan

  Form is External to Site
 State Health Plan-SmartChoice PPO Enrollment Application

  Form is External to Site
Leave Forms and Letters
 Academic Family and Medical Leave Letter

This is a sample letter that the department head can use when responding to the academic year employee's request for FML.

Word Document Icon    
 Family and Medical Leave Application (FML)

Complete this form when requesting Family Medical Leave.

Word Document Icon PDF Document Icon  
 Family and Medical Leave Letter

This is a sample letter that the supervisor can use when responding to the employee's request for FML.

Word Document Icon    
 Family Illness Leave Request Form (FIL)

Complete this form when requesting Family Illness Leave.

Word Document Icon PDF Document Icon  
 Family Illness Leave Request Letter

This is a sample letter that the supervisor can use when responding to the employee's request for FIL..

Word Document Icon    
 Health Care Provider Certification Form

This form must be completed by your health care provider and attached to your application for Family Medical or Family Illness Leave.

PDF Document Icon  
 Scholarly Leave Assignment Form

Complete this form to request Scholarly Leave Assignments.

PDF Document Icon  
 Shared Leave Application

Complete this form when requesting Shared Leave.

Word Document Icon PDF Document Icon  
 Shared Leave Donation Authorization Form

Complete this form to donate Shared Leave to a participant in the Shared Leave program.

Word Document Icon PDF Document Icon  
Life Insurance
 MetLife Beneficiary Form

PDF Document Icon  
 MetLife Enrollment Form

To enroll in the MetLife Insurance

PDF Document Icon  
 MetLife Statement of Health Form

Statement of health questions for employees to enroll or increase coverage in the MetLife Insurance during the year

Word Document Icon    
NC Flex
  AD&D Beneficiary Form

PDF Document Icon  
  AD&D Portability Form

  Form is External to Site
  Cancer Claim Form

To submit a cancer claim

  Form is External to Site
  Cancer Plan Conversion Form

To convert Cancer plan to home billing once employee separates Emp

  Form is External to Site
  Cancer Plan Evidence of Insurability Form

  Form is External to Site
  Dental Claim Form

To submit a dental claim

  Form is External to Site
  Enrollment Form

To enroll in NC Flex plans

  Form is External to Site
  HIPAA Authorization Form

Authorize others to access information on Dental, NC Flex Spending Accounts, Supplemental Medical, and the Vision Plan

  Form is External to Site
  Status Change Form

To make coverage changes to NC Flex plans

  Form is External to Site
  Term Life Beneficiary Change Form

To update beneficiary NC Flex Term Life Insurance

  Form is External to Site
  Term Life Continuation Form

To convert Term Life plan to home billing once employee separates Emp

  Form is External to Site
  Term Life Death Claim Form

To process a death claim for NC Flex Term Life Insurance

  Form is External to Site
  Term Life Evidence of Insurability Form

Completed when over $100,000 in coverage requested for new hires, or during the annual enrollment to add or increase coverage

  Form is External to Site
  Vision Plan Claim Form

PDF Document Icon  
 Convenience Card Enrollment Form

To enroll in the NC Flex spending accounts convenience card

  Form is External to Site
 Flexible Spending Account Claim Form

To make a claim on the NC Flex Flexible Spending Accounts or to send in Convenience Card receipts.

  Form is External to Site
 Flexible Spending Account Convenience Card Dependent Card Request Form

To enroll dependents to have a NC Flex spending accounts convenience card

  Form is External to Site
 Online Enrollment System

To enroll in NC Flex plans online

  Form is External to Site
 Supplemental Medical Claim Form

To submit Supplemental Medical claim

  Form is External to Site
Orientation
 NEO Enrollment Form

Electronic form for Campus Department to complete to enroll a new hire in New Employee Orientation

  Form is External to Site
Prepaid Legal Plan
 Hyatt Legal Enrollment Form

To enroll in the Legal plan

PDF Document Icon  
Recognition
 NC OSP Employee Incentive Program Form

  Form is External to Site
 Pride of the Wolf Pack Award Nomination Form

Electronic form to nominate employees for the Pride of the WolfPack Award

  Form is External to Site
 State Retirement Certificate Request Form

Submitted by Departments for Employees that are retiring and request a retirement certificate

PDF Document Icon  
 University Awards for Excellence Media Release Form

Media Release form all winners of the University Awards for Excellence complete before their information is listed in the press and online

PDF Document Icon  
 University Awards for Excellence Nomination Form

Completed to nominate an employee for the Awards for Excellence program

PDF Document Icon  
 WolfPerks Business Partner Application

Electronic form for potential businesses that want to participate in the WolfPerks employee discount program

  Form is External to Site
Retirement
 Acknowledgement for Disposition of Account Contributions Form (Optional Retirement Program)

ORP-3 Acknowledgement for Disposition of Account Contributions-Completed once employee seperates Emp to verify vesting status with ORP program

  Form is External to Site
 Additional TSERS Forms

NC Department of State Treasurer Forms Page

  Form is External to Site
 Application for Retirement Form

To apply for retirement with the State Retirement System or Law Enforcement Officer Retirement System

  Form is External to Site
 Authorization for Coverage Under the State of NC Retired Group Health Plan (Optional Retirement Program)

ORP-4 Authorization for coverage with the State of North Carolina Retired Group Health Plan-For retired employees with ORP to continue the heatlh plan in retirement

  Form is External to Site
 Direct Deposit Authorization Form

Direct Deposit form for retire benefit

  Form is External to Site
 Election of Optional Retirement Program ORP-1 Form

1A-Election form the ORP-to enroll in the ORP plan

  Form is External to Site
 Law Enforcement Officers Retirement System Change of Beneficiary/Address Form

To change beneficairy or address information for the Law Enforcement Officers Retirement System

  Form is External to Site
 Law Enforcement Officers Retirement System Notice of Enrollment

To enroll and list beneficiary information for Law Enforcement Officers Retirement System

  Form is External to Site
 Medicare Request for Employment Information Form

Completed to identify retirement date for Medicare on retirees age 65 and older

PDF Document Icon  
 Notice of Change in Investment Election Optional Retirement Program ORP-2 (Rev. 10/1999)

2A-Change in Investment election for ORP-Change future ORP contibutions between the four vendors

  Form is External to Site
 Retirement Calculation Request Form

To request an estimate of retirement for the State Retirement System and Law Enforcement Officers Retirement System

  Form is External to Site
 Retirement Contributions Refund Form

To request a refund of retirement contributions (on termination) for the State Retirement System and Law Enforcement Officers Retirement System

  Form is External to Site
 Social Security Form for Medicare

For retirees age 65 and older to apply for Medicare coverage

PDF Document Icon  
 State Health Plan Retiree Enrollment Form

To enroll in the Retiree State Health Plan

  Form is External to Site
 Teachers' and State Employees' Retirement System Change of Beneficiary/Address Form

To change beneficairy or address information for the State Retirement System

  Form is External to Site
 Teachers' and State Employees' Retirement System Notice of Enrollment

To enroll and list beneficiary information for State Retirement System

  Form is External to Site
 TSERS Federal and State Income Tax Withholding Election Form

Federal and State Tax witholding form for retirement benefit

  Form is External to Site
Tuition Waiver
 Faculty/Staff Tuition Waiver Form

Application for the Faculty and Staff tuition waiver

  Form is External to Site
Voluntary Retirement
 401(k) Beneficiary Designation Form

  Form is External to Site
 401(k) Change Form

To change address or contribution to the 401(k) plan

  Form is External to Site
 401(k) Enrollment Form

To enroll in the 401(k) plan

  Form is External to Site
 401(k) Request for Disbursement

  Form is External to Site
 403(b) Salary Reduction Agreement Form

To start or change payroll deduction for the 403(b)

PDF Document Icon  
 457 Enrollment, Deferral Change and Beneficiary

  Form is External to Site
WolfPup Childcare Program
 Wolfpup Childcare Brochure

PDF Document Icon  
 Wolfpup Childcare Registration Form

PDF Document Icon  
Workers Compensation
 Aviso de Accidente y Reclamo del Empleado, Representante ó Dependiente, NCIC, La Forma 18

Utilizado por un empleado divulgar lesión o una enfermedad profesional a la Comisión industrial.

  Form is External to Site
 Employee Statement and Leave Options Form

Employees description of work related accident and injury, including employees choice to use leave during the seven day waiting period for Workers' Compensation.

PDF Document Icon  
 Employer’s Report of Injury or Occupational Disease to the Industrial Commission, NCIC Form 19 (Supervisors)

To report an employee's injury or occupational disease to the Industrial Commission

PDF Document Icon  
 First Report of Injury Form

Completed to report work related injury, illness, or near miss

  Form is External to Site
 Medical Authorization and Attending Physician's Report

Physician completes for a Workers Compensation situation

PDF Document Icon  
 Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for Workers' Compensation Benefits. NCIC, Form 18

Used by an employee to report an injury or occupational disease to the Industrial Commission.

  Form is External to Site
Classification & Compensation Services
Career Banding
 Career Banding Job Description

Complete this form for creating a new or changing the title of a career banded position.

Word Document Icon PDF Document Icon  
 Career Banding Salary Adjustment

Complete this form to request a salary adjustment for an employee in a career banded position.

Word Document Icon    
 Competency Assessment for Banded Position

Complete this form for employees that are career banded to assess their competencies or request a level change.

Word Document Icon PDF Document Icon  
Compensation Request Forms
 FLAT RATE REQUEST FORM

Word Document Icon    
 Request to Pay Over Hourly Pay Rate Maximum

Word Document Icon    
 SPA Supplemental Pay

Word Document Icon PDF Document Icon  
EPA Classification Forms
 Additional Compensation Approval Form, EPA

Form required for additional compensation approval

Word Document Icon    
 Analysis Tool for FSLA Exemption

Analysis Tool for FSLA Exemption

Word Document Icon PDF Document Icon  
 Analysis Tool for Possible Non-Faculty EPA Status

Complete this form to assist in determining if a position qualifies for EPA status as Instructional or Research Non-Faculty

Word Document Icon    
 BOT/BOG Personnel Action Approval

Personnel Action requiring approval of the Board of Govrnors and/or the Board of Trustees

Word Document Icon    
 Cover Sheet for EPA Personnel Actions Requiring BOT or BOG Approval (HR-017)

Word Document Icon PDF Document Icon  
 EPA Personnel Action Form

Complete this form to request a change in title and/or salary for an existing EPA position.

Word Document Icon PDF Document Icon  
 New EPA Position Request Form

Complete this form to create a New EPA Position

Word Document Icon    
SPA Action & Job Description Forms
 Accounting Support Questionnaire

Complete this form for position action requests on classification series such as Accounting Clerks, Accounting Technicians, Accounting Specialists

Word Document Icon PDF Document Icon  
 Administrative Management Form

Complete this form for position action requests on classification series such as Administrative Assistants, University Administrative Managers

Word Document Icon PDF Document Icon  
 General Form

Complete this form for position action requests on all other classification series

Word Document Icon PDF Document Icon  
SPA Additional Classifications
 Accounting Support Data Sheet Form

Complete this form with budget data information for an Accounting Support position

Word Document Icon PDF Document Icon  
 ADA Checklist Form

Complete this form to indicate the physical efforts required by a specific position.

Word Document Icon PDF Document Icon  
 Administrative Support Data Sheet Form

Complete this form with budget data information for an Administrative Support position

Word Document Icon PDF Document Icon  
 Ag Research Support Data Sheet Form

Complete this form with additional information for an Ag Research Support position

Word Document Icon PDF Document Icon  
 In-Range Salary Adjustment Request

This form covers job change, temp job change, equity, and labor market adjustments. Complete this form to request an in-range salary adjustments for SPA positions.

Word Document Icon    
 Interview Preparation Guide

Provides an outline of what to expect during the interview/audit process of a position action review

Word Document Icon PDF Document Icon  
 Position Status Change Request Form

Complete this form for Status Change, FTE Change, and Abolishment requests

Word Document Icon PDF Document Icon  
 Student Services Support

Complete this form with budget data information for a Student Services Support position

Word Document Icon PDF Document Icon  
Employee Relations
Discipline Templates
 Demotion Template, SPA

used by supervisors as a guideline to write a demotion letter for an SPA employee.

Word Document Icon    
 Dismissal Template, SPA

used by supervisors as a guideline to write a dismissal letter for an SPA employee.

Word Document Icon    
 Probationary Employee Dismissal Template, SPA

Template used to dismiss a Probationary SPA Employee

Word Document Icon    
 Suspension without Pay Template, SPA

used by supervisors as a guideline to write a suspension without pay letter for an SPA employee.

Word Document Icon    
 Written Warning Template, SPA

used by supervisors as a guideline to write a writing warning for an SPA employee.

Word Document Icon    
Exit Interview Forms
 Asset Tracking Form

This Form should be used to track University assets that are assigned to the individual for authorized business use. The form should be reviewed when an individual separates from the University to ensure proper asset retrieval.

Word Document Icon PDF Document Icon  
 Exit Interview Questionnaire

used to collect information that contributes to retention and turnover, and provides exiting employees an opportunity to voice concerns and make suggestions. Must be completed by all exiting employees.

Word Document Icon PDF Document Icon  
 Exit Interview Questionnaire (online) for SPA and EPA non-faculty

Online questionnaire used to collect information that contributes to retention and turnover, and provides exiting employees an opportunity to voice concerns and make suggestions. Must be completed by all exiting employees.

  Form is External to Site
 Separation Clearance Checklist

This form ensures retrival of University assets from exiting employees. It provides both exiting employees and their supervisors with guideliness needed to complete the separation proccess.

Word Document Icon PDF Document Icon  
Grievance and Performance Forms
 Grievance Form, SPA

used to file a formal SPA Grievance.

Word Document Icon PDF Document Icon  
 Grievance Panelist Interest Form

Must be completed by employees interested in becoming SPA Grievance Panel Members.

Word Document Icon    
 Performance Pay Dispute Form, SPA

To file for a review of a performance pay issue or a performance evaluation rating.

Word Document Icon PDF Document Icon  
Mediation
 Agreement to Mediate Form

This form provides mediation participants basic information about limits of the mediation process. It is provided by the Program Coordinator and/or the mediators at the time of mediation. Participant signatures are required. The completed form is maintain

PDF Document Icon  
 Expectations of Volunteer Mediators Form

This form outlines the expectations of Program mediators, and serves as an agreement for mediators to participate in the University Mediation Program.

PDF Document Icon  
 Mediation Agreement Format

This form provides a format for parties to document agreements developed during the mediation session. It is retained by the parties.

PDF Document Icon  
 What to Expect at Mediation Handout

This handout serves as a confirmation of the scheduled mediation and provides an overview of the mediation process. It is provided to the parties prior to the mediation sessions by the Program Coordinator or the mediator(s).

PDF Document Icon  
Performance Management Forms
 Assignment Matrix for Banded Positions

optional replacement for the Key Responsibilities Summary.

Word Document Icon    
 Key Responsibilities Summary for Banded Positions

Outlines Key Responsibilities and Expected Levels of Performance for Career Banded positions.

Word Document Icon    
 SPA Career-Banded Work Plan and Appraisal Form

Form used to establish annual work plans and evaluate an SPA employee's competencies and performance in BANDED POSITIONS.

Word Document Icon PDF Document Icon  
 Work Plan & Performance Appraisal, SPA

used to establish annual work plan and to evaluate an SPA employee's performance.

Word Document Icon PDF Document Icon  
Transfer Forms
 Transfer Appraisal Form

must be completed by the employee, supervisor, and appropriate level of management prior to an employee transferring to another state agency or department on campus.

Word Document Icon PDF Document Icon  
Employment
EPA Checklists
 Employment Documentation Form for New EPA Employees (HR-002)

Supplies demographic, Selective Service and other information for new EPA employees

Word Document Icon PDF Document Icon  
 Hiring Credentials Checklist for New No Pay EPA Employees (HR-003)

Lists documents required to enter a new, non-paid employee into the HRIS

Word Document Icon PDF Document Icon  
 Hiring Credentials Checklist for New Paid EPA Employees (HR-001)

Lists documents required to enter a new, paid employee into the HRIS

Word Document Icon PDF Document Icon  
 Hiring Credentials Checklist for Rehire Actions (HR-REH)

Lists documents required to rehire both paid and non-paid employees

Word Document Icon PDF Document Icon  
 Hiring Package Checklist for New Paid EPA Employees (HR-022)

Lists documents for which completion is necessary at the time of an employment offer

Word Document Icon PDF Document Icon  
 HR I-9 Coversheet for completing an action to enter/update the I-9 fields

Coversheet for submitting an action to enter/update the I-9 fields in the HRIS

Word Document Icon PDF Document Icon  
 Job Request Actions for EPA Employees (HR-JOB)

Provides a list of possible required documents for current employee job requests

Word Document Icon PDF Document Icon  
 Personal Data Actions (HR-PERS)

Lists documents required to update personal data information in the HRIS

Word Document Icon PDF Document Icon  
 Separating/Retiring EPA Employees (HR-TERM)

Lists documents required to terminate separating/retiring employees

Word Document Icon PDF Document Icon  
EPA Employment
 EPA Applicant Flow

Used to track applicants for EPA vacancies.

Word Document Icon    
 EPA Final Recruitment Report

To be completed and approved before making an offer to the final candidate for EPA vacancies.

Word Document Icon    
 EPA Interim Recruitment Report

To be completed and approved before conducting interviews for EPA vacancies.

Word Document Icon    
 EPA Notification Letter

To notify all candidates not hired for EPA vacancies.

Word Document Icon    
 EPA Offer Letters

Template letters required to offer EPA employment

  Form is External to Site
 EPA Recruitment and Selection Guidelines

To guide hiring officials through the recruitment and selection process of EPA vacancies.

PDF Document Icon  
 EPA Request for Waiver of Recruitment

Used to hire EPA employees in exceptional circumstances when usual search process is not followed.

Word Document Icon    
 EPA Time-Limited Appointment Form

Used to appoint short-term (1-2 year) appointments for EPA vacancies or for Post-Docs (up to 5 years).

Word Document Icon    
 Notice of EPA Vacancy

To be completed in order to post an EPA vacancy.

Word Document Icon    
 Patent Agreement

A form to confirm understanding of NC State Patent and Copyright Procedures.

Word Document Icon PDF Document Icon  
General Employment
 Acceptance of Temporary Employment Terms

Fill out this form to certify Temporary Employee understands the terms of employment.

Word Document Icon PDF Document Icon  
 Background Check Disclosure and Release

Word Document Icon PDF Document Icon  
 Background Check Disclosure and Release (continued)

Word Document Icon PDF Document Icon  
 Background Check Guidelines

Regular faculty, special faculty, EPA non-faculty professionals, post-docs, EPA time limited, EPA waiver appointments, SPA staff hires & transfers

PDF Document Icon  
 Employment Eligibility Verification Form (I-9)

For all employees and students going on payroll to document Emp eligibility in the United States.

  Form is External to Site
 New Employee Safety Training Checklist

To be completed and reviewed will all new employees.

  Form is External to Site
 New Employees Checklist

A one page checklist for things that will need to be done for each new employee. (Your may have additional items specifcally for your unit.)

PDF Document Icon  
 Personal Information Form (PIF) - Regular/Monthly

Word Document Icon PDF Document Icon  
 Personal Information Form (PIF) - Temporary/Part Time

Word Document Icon PDF Document Icon  
 Pre-Employment Inquiry Guide

A list of permissible inquiries and those that should be avoided during the recruitment process.

PDF Document Icon  
 Sample Interview Questions

A list of sample questions that may be asked during interviews.

PDF Document Icon  
 Selective Service Certification

Selective Service Registration Certification for Male Temporary and Graduate Student Workers

Word Document Icon    
 Telephone Reference Guide

Guidelines for hiring officials when completing Emp references for new employees.

PDF Document Icon  
Staff Employment
 Recruitment & Selection Checklist

A one page checklist to guide hiring officials through the staff recruitment process.

PDF Document Icon  
 Sample Notification Letter

Sent to applicants who were interviewed but not selected.

PDF Document Icon  
 Sample Offer Letter

Completed at time of hire for new staff employees

PDF Document Icon  
 Secondary Employment Certification Form

Staff (SPA) employees must complete this form prior to accepting secondary Emp.

Word Document Icon PDF Document Icon  
 Staff Recruitment and Selection Guidelines

To guide hiring officials through the recruitment & selection process for staff vacancies.

PDF Document Icon Form is External to Site
 Time-Limited Acceptance

Completed at time of hire for staff employees hired under Time-Limited status

PDF Document Icon  
Temporary Employment
 Temporary Applicant Tracking Form

MS Excel Document Icon    
 Temporary Employee Application (non UTS)

Fillable Non-UTS temporary employee application

PDF Document Icon  
 Temporary Employee Recruitment Guidelines/FAQ's

  Form is External to Site
Human Resources Information Management
Personnel Action Forms
  Personal Information Form (PIF) - Regular/Monthly

Word Document Icon PDF Document Icon  
  Personal Information Form (PIF) - Temporary/Part Time

Word Document Icon PDF Document Icon  
 Annual and Bonus Leave Payment Authorization

To payout Annual and Bonus leave for EPA and SPA Employees.

Word Document Icon    
 Correction, Rehire, and Transfer Earnings Distribution Continuation Page

Word Document Icon    
 Correction, Rehire, and Transfer Form

Word Document Icon    
 Education/Contract Form

  Form is External to Site
 Job Data Form

  Form is External to Site
 Personal Data Form

  Form is External to Site
 Personal Data Form (PDF) Instructions

Instructions on how to find and use the online Personal Data Form (PDF), Job Data, Personal Data, and Education/Contract Forms.

PDF Document Icon  
Timesheets
 Timesheet Inclusive Dates, SPA

This document lists the begin and end dates for the permanent timesheet for employees paid monthly.

  Form is External to Site
 Timesheet, SPA - BiWeekly

Word Document Icon PDF Document Icon  
 Timesheet, SPA - Permanent Employees

MS Excel Document Icon    
 Timesheet, SPA - Permanent Employees

PDF Document Icon  
International Employment
General Forms
 Actual Wage Determination Form

Filled out by employing department listing minimum job requirements and salary for the H-1b position. Filled out with the Actual Wage Statement.

Word Document Icon    
 Actual Wage Statement Form

Filled out by employing department listing all similarly employed people in department in same position as the H-1b sponsored emloyee.

Word Document Icon    
 H-1b Visa Request Form

Used by employing department to formally ask I.E. to start H-1b process on an employee.

Word Document Icon    
 Initiation of Permanent Residency Process

Used by employing department to formally ask I.E. to start Permanent Residency process on an employee.

Word Document Icon    
 Notice of Intent To Employ An H-1b Non-Immigrant

Notice that must be posted in two places within department for 10 days for the H-1b process.

Word Document Icon    
 Prevailing Wage Request Form

Filled out by employing department to list minimum job qualifications for the position for an H-1b visa.

Word Document Icon    
 Remote Hire I-9 Instructions and Form

Word Document Icon PDF Document Icon  
 Sample Sponsor Letter

This sample letter is separate from the official, original appointment or the offer letter, and does not have to coincide with appointment dates. It is for H-1B time period requests to USCIS only.

Word Document Icon    
Payroll
General Payroll Forms
 Address Change Form

Complete this form to change your home address with the Payroll Office

Word Document Icon PDF Document Icon  
 Check Distribution Coordinator Update Form

Complete this form to add/change/delete CDC locations

Word Document Icon PDF Document Icon  
 Deduction Cancellation Form

Complete this form to cancel some payroll deduction

Word Document Icon PDF Document Icon  
 Direct Deposit Form

Complete this form to enroll in, change or cancel your direct deposit

Word Document Icon PDF Document Icon  
 Direct Deposit Form (Spanish)

Complete this form to enroll in, change or cancel your direct deposit

PDF Document Icon  
 Employee Working Outside North Carolina Form

Complete this form when you have an employee who will be working outside North Carolina for any part or all of their employment. This form must be completed prior to departure and upon return if applicable.

PDF Document Icon  
 Lost Check Affidavit

Complete this form to request a replacement check for a lost/stolen/destroyed payroll check

PDF Document Icon  
 Manual Check Request Form

Departments complete this form to request a manual check.

Word Document Icon PDF Document Icon  
 Request to Print Pay Statement

Complete this form to request that your pay statements be printed each payday because you do not have access to a computer to print them.

PDF Document Icon  
Payroll Tax Forms
 Duplicate W-2 Request Form

Complete this form to request a duplicate W-2

Word Document Icon PDF Document Icon  
 Federal Tax (W-4)

Federal tax withholding certificate/worksheet

PDF Document Icon  
 Federal Tax (W-4) (Spanish)

Federal tax withholding certificate/worksheet in Spanish

PDF Document Icon  
 Social Security Exemption Form

NC State enrollment exceptions for student social security exemption

Word Document Icon    
 State of North Carolina Tax (NC - 4) Form

State of North Carolina tax withholding certificate/worksheet.

PDF Document Icon  
Training & Organizational Development