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.

On-line Job Application Submission System
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
2018 W4 Form
Ergonomic Sitting Graphic
Ergonomic Reminder Sheet

Ergonomic Check List
This form can be downloaded to your personal computer, completed within excel with the correct information, printed, and faxed to the Flexible Benefit Management Company

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