Helpful Information for Current Employees

Address or Name Change Forms

The process for address and/or name changes is available: Address/Name Change Process (PDF). Please fill out the applicable forms for your address or name change. The Churchill County form will cover you for health, dental and vision insurance. A new W-4 form must be filled out because we need to have your most recent name and address indicated on your W-4 form.

• Churchill County Change Form (PDF) - Return to Human Resources once filled out.
• W-4 Form (PDF) - Return to Human Resources once filled out.
• PERS Change Form (PDF) - Return to Human Resources once filled out.
• Voya (Deferred Comp) Change Form (PDF) - Email or fax directly to Nevada Deferred Comp
• Western Insurance Specialties (Term Life Insurance) Change Form (PDF) - Submit directly to Western Insurance Specialties once filled out.

Direct Deposit Form

If you are interested in having your paycheck directly deposited into your bank account, use the following form:

• Direct Deposit Form (PDF) - Return to Human Resources or the Comptroller's Office once filled out. Be sure to attach a voided check, a copy of a check, or a Direct Deposit information form provided by your financial institution.

Workers' Compensation

• C-1 (Notice of Injury) Form (PDF) - To be filled out and turned in to the supervisor when an employee is injured.
• Workers' Comp "Insurance Card" (PDF) - Can be used by an employee when receiving medical care for a work-related injury or illness.
• Workers' Comp First-Fill Form (PDF) - To be brought by the employee to a pharmacy, if needed, for a prescription for a workers' compensation injury.

Administrative Policies

There are some administrative policies passed by the Board of County Commissioners that are not a part of Title 3. They may be found in the Administrative Policy Manual (PDF).