GRAND FORKS COUNTY

APPENDIX TO

EMPLOYEE POLICY AND PROCEDURE MANUAL

 Effective March 17, 2008

APPENDIX TABLE OF CONTENTS  

 This form in pdf format                                                                                  

Application for Employment (county) (form 1)

Application for Employment (SFN 10950), merit system positions (form 2)

Notice of Employee Change – Grand Forks County (form 3)

Employee Emergency Contact Form (form 4)

ND PERS forms

• Employee’s Membership Application for Retirement (SFN 2561) (form 5)
• Designation of Beneficiary (SFN 2560) (form 6)
• Notice of Change (SFN 10766) (form 7)
• Life Insurance Enrollment/Change (SFN 53803) (form 8)

Worker’s Compensation (WSI) and Risk Management Forms

• Near Miss Report (form 9)
• Incident Report (form 10)
• First Report of Injury SFN 2828 (form 11)
• Capability Assessment SFN 58550 (form 12)
• Employee Post-Accident Procedure Form (C-4) (form 13)
• Designated Medical Provider Form (form 14)

Employee Attendance Record (county) (form 15)

Time at Work Record (Social Services) (form 16)

Request for Alternate Work Schedule (form 17)

Additional Outside Employment Agreement (Social Services) (form 18)

Form W-4 (sample) (form 19)

Disciplinary Action Report (form 20)

Employee Warning Notice (form 21)

Employee Grievance Form (Merit System Employees) (form 22)

FMLA Application (form 23)

Certification of Health Care Provider (form 24)

Leave Donation Request (form 25)

Leave Donation Form (form 26)