Town of Chapel Hill, NC
Home MenuCommonly Used Forms
This page contains links to some of the most common forms that employees need. . We are including them on our public website so that employees can access them at anytime from any computer. Some of the forms can be filled out online; others must be printed, filled out, and returned as paper copies. The Town, as part of its policy improvement project, is working on streamlining forms and making it easier to submit them online. Please bear with us and check back regularly as we add forms and improve their functionality. If you have any questions about any of the forms, please contact Human Resource Development for more information.
LEAVE DONATION FORMS (see the Leave Donation Policy for more information)
Employees may request donated leave to help them during extended periods of absence due to medical conditions. Certain conditions apply. Please ask your supervisor or department head for assistance.
DISCIPLINARY ACTION FORMS (see the Disciplinary Action policy for more information)
These forms help supervisors manage the formal disciplinary process.
- Written Warning Checklist 5-3A
- Written Warning Template 5-3B
- Written Warning-Employee Response 5-3C
- Pre-Disciplinary Conference Notification template 5-3D
- Disciplinary Action Checklist 5-3E
GRIEVANCE FORMS (see the Grievance Policy for more information)
Employees may file a grievance to dispute a serious disciplinary decision that involves demotion, suspension, or termination.
DISPUTE RESOLUTION FORMS (see the Dispute Resolution Policy for more information)
The Town offers formal dispute resolution assistance to assist employee in resolving workplace issues after internal efforts have been unsuccessful. The Town uses independent mediators.
- Dispute Resolution Request 5-4A
- Agreement to Mediate 5-4B
- Confidentiality Agreement 5-4C
- Memorandum of Mediation Agreement 5-4D
- Notice of Mediation Impasse 5-4 E
- Mediation Exit Survey 5-4F
- Management Review Decision Template 5-4G
FAMILY AND MEDICAL LEAVE ACT REQUESTS (see the FMLA Policy for more information)
FMLA is a federal law that provides job protection for qualifying employees who are dealing with their own or a qualifying family member's serious medical condition. We highly recommend you contact LaTisha Perry, HRD Technician, at extension 5032 for information and assistance in applying for FMLA.
- Request for FMLA (filled out by EMPLOYEE)
- Certification of Healthcare Provider (use this form for employee's OWN medical condition)
- Certification of Healthcare Provider/Family (use if the leave request is to care for a qualifying family member)
NON -FMLA MEDICAL LEAVE OF ABSENCE
Employees can apply for a non-FMLA medical leave for situations that do not qualify for FMLA. See the Town's Non-FMLA Medical Leave of Absence Policy for more information on how to apply.
PARENTAL LEAVE (see the Town's Parental Leave Policy for more information)
The Town offers six weeks of paid parental leave for qualifying employees. Parental leave runs concurrently with FMLA. Please contact Human Resource Development for more information and assistance in applying for Parental Leave.