• Dear Halifax County School Employee,

    The following forms are included in the packet to assist with your decision and application process for short term disability income plan. 

    • Guide to Determining and Recording Short Term Disability Benefits. The directions are listed under action on the right-hand side.
    • Form 701
    • Form 703
    • Form 7A
    • Pages from the State Employment Benefits Manual relevant to the Disability Income Plan for your reference. 

    Once you can, complete and return forms 701, 703, and 7A, the school division will complete forms 700, 711, and attach a job description to submit to the retirement. Please note form 703 is required to be submitted monthly once short term disability is granted. 

    Please return the forms listed above to the Human Resources Department at your earliest convenience. If you have any questions, please do not hesitate to contact the Human Resources Department. 

    Thank you for your time. 

    P.O. Box 468-9525 HWY 301 S Halifax NC 27839

    (P) 252.583.5111 (F) 252-583-1383

     

Forms