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 brooke.watson@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.

Address/Name change forms
Direct Deposit change form

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
W-4 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