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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE—ID—S—AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Stafford <br />FIRST NAME <br />Michael <br />EMPLOYEE # <br />S1503 <br />EFFECTIVE DATE <br />09/02/2015 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />LJ FULL-TIME (1) <br />❑ PART-TIME (2) <br />❑ LIMITED PART-TIME (3) <br />❑ TEMPORARY (4) <br />❑ CASUAL (5) <br />❑ SEASONAL (6) <br />❑ PROJECT (7) <br />❑ WORK STUDY (8) <br />❑ VOLUNTEER (9) <br />❑ NEW HIRE <br />❑ RE -HIRE <br />❑ MERIT/ STEP <br />0 POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />❑ TERMINATION (Provide Separation Info) <br />❑ OTHER (Describe Below) <br />❑ DISCHARGE (D) <br />❑ RESIGNATION (C1) <br />❑ RETIRED tR) <br />❑ LAID OFF (L) <br />❑ FAIL PROBATION (P) <br />❑ OTHER (0) <br />❑ PERFORMANCE (P) <br />❑ ATTENDANCE (A) <br />❑ CONDUCT (C) <br />❑ OTHER EMPLOYMENT (E) <br />❑ PERSONAL (L) <br />❑ OTHER (0) <br />❑ Eligible For Rehire ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: Placement to new position as Juvenile Court Administrator as indicated in 2015 Budget. 6. <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />ASST JCA/PROBATION MANAGER <br />Juvenile Court Administrator <br />OCCUPATION CODE <br />2327 <br />UNION CODE <br />30 <br />PAY GRADE <br />227 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt Q Exempt ❑ Not Covered <br />❑ Non -Exempt [j] Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑ PERS ❑ LEOFF [j] PSERS ❑ Other <br />❑ Ineligible ❑ PERS ❑ LEOFF 0 PSERS ❑ Other <br />HIRE DATE <br />1/27/2003 <br />ADJ HIRE DATE <br />1/27/2003 <br />POSITION DATE <br />1/27/2003 <br />09/02/2015 <br />LAST RAISE DATE <br />1/1/2015 <br />BASE WAGE <br />$ 5,021.00 <br />$ 5,272.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />Q 100% ❑ 80% ❑ 75% ❑ 60% [:150% <br />Q 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 5,021.00 <br />$ 5,272.00 <br />PAYMENT METHOD <br />❑ HOURLY Q MONTHLY <br />❑ HOURLY Q MONTHLY <br />DEPARTMENT <br />JUVENILE PROBATION <br />BUDGET NUMBER <br />_ <br />A. 001 000000000220151001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />T Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />I] Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, <br />or other, it must be listed in both columns foraudit purposes or the amount will default to "0". <br />ALLOWANCE (Detail in Comments Section) $ 0.00 $ 0.00 <br />STIPEND (Detail in Comments Section) $ 0,00 $ 0.00 <br />OTHER (Detail in Comments Section) <br />$ 0.00 $ 0.00 <br />r ' <br />SECTION 4: SIGNATURES( LIST BE SIGNED IN BLUE <br />QIfPARTMj,KT H -50b LJX6CTtDOFFfCIAL DATE <br />BUDGET/PAYROLL 7 DATE ' <br />Ift0fol-AN RESOURCE `z <br />DATE <br />COMMIS 41 DATE <br />COMMI `NERC,#2 <br />DATE <br />CoNNW6515NER # r DA E <br />RETURN FOR TO H MAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE—ID—S—AA—S) Initial <br />