Pulaski County Human Resources
Chastity D. Scifres, J.D.

201 S. Broadway, Suite 100
Little Rock, AR 72201
Phone: (501) 340-6110
Fax: (501) 340-6033

Pulaski County Information for Supervisors and Employees

Forms for County Employees

125 Enrollment Form

APERS Enrollment Change Request

Approval of Outside Employment

Cafeteria Waiver/Enrollment

Direct Deposit Authorization Form

Direct Deposit Sign-Up Sheet

Employee Self-Certification to Return to Work

FMLA – Application for Leave of Absence

FMLA – Certification of Health Care Provider – Employee’s Serious Health Condition

FMLA – Certification of Health Care Provider-Family Member’s Health Condition

Request for Seminar-Workshop-Conference Expense

Pulaski County Personnel Policy

Pulaski County Purchasing Policy

Substance Abuse Handouts

Tuition Expense Form

USAble Life Insurance – Group Enrollment or Change

USAble Life Insurance – Evidence of Insurability

USAble Voluntary Life Insurance


Income Tax Withholding – Federal – W4

Income Tax Withholding – State- AR4EC

Travel Forms

Advance Travel Request Form
Travel Authorization Form Reimbursement
Federal Per Diem Information
Mileage Form 2021
Travel Expense Form 2016
Per Diem Travel Advance Request

Forms for County Supervisors

Approval of Outside Employment

Background Check Consent Form

Background Check Pre-Adverse Action Letter

Background Check Final Adverse Action Letter

Budget Worksheet – 2016

Employment Eligibility Verification – I-9

FMLA – Notice of Eligibility & Rights and Responsibilities

FMLA – Designation Notice

Reasonable Suspicion Documentation

Part-time/Extra Help – Approval over $11.00

Performance Evaluation – Annual

Performance Evaluation – Quarterly

Pulaski County Purchasing Policy

Job Evaluation – Existing Position Request

Job Evaluation- Job Analysis Questionnaire

Job Evaluation – New Position

Workers’ Compensation – First Report of Injury or Illness

Workers’ Compensation – Employee’s Notice of Injury

Workers’ Compensation – Supplemental Report

To report problems with the Email or Self Service System contact Information Systems at 340-8456 or contact webmaster@pulaskicounty.net