HR Forms

Rutherford County Human Resources Department
289 N. Main St.
Rutherfordton, NC 28139
Phone: 828-287-6145 - Fax: 828-287-6262

These forms can be downloaded, printed, or submitted on-line and then mailed to the above address, emailed to debra.conner@rutherfordcountync.gov or faxed.

IT IS THE RESPONSIBILITY OF THE APPLICANT/EMPLOYEE TO CONTACT THE HUMAN RESOURCES OFFICE FOR VERIFICATION OF RECEIPT OR FORMS/APPLICATION.


Form 19—Employer’s Report of Employee’s Injury or Occupational Disease

OSHA’s Form 301 - Injury and Illness Incident Report
Worker's Comp. Pharmacy Card

Family Medical Leave Act Form (FMLA)
 for Employee
FMLA form for Family Member

New Employee Password Request Form


New NC-4 Withholding Forms
2019 W4 Form

Ergonomic Sitting Graphic
Ergonomic Reminder Sheet
Ergonomic Check List

Performance Evaluation Forms
These forms are the performance evaluation forms that each employee of Rutherford County viewed during their HR meetings