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KITTITAS COUNTY PERSONNEL ACTION FORM (P <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />WILLIAMS <br />EMPLOYEE TYPE <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />MACKENZIE W2361 11/16/15 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE ACTION TYPE OF SEPARATION I REASON FOR SEPARATION <br />® 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 ❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />❑ RE -HIRE ❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ MERIT/ STEP ❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ POSITION CHANGE (Describe Below) ❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ BUDGET CHANGE (Describe Below) ❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ LEAVE (List Type Below) ❑ OTHER (0) ❑ OTHER (0) <br />❑ TERMINATION (Provide Separation Info) <br />E OTHER (Describe Below) ❑ Eligible For Rehire ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: EMPLOYEE IS HOLDING BOTH POSITIONS (LE CLERK AND RESERVE DEPUTY). <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report Enter new data <br />JOB TITLE <br />LAW ENFORCEMENT CLERK RESERVE DEPUTY <br />OCCUPATION CODE <br />5761 <br />5801 <br />UNION CODE <br />72 <br />89 <br />PAY GRADE <br />561 <br />501 <br />STEP / POSITION <br />2 <br />3 <br />FLSA STATUS <br />® Non -Exempt ❑ Exempt ❑ Not Covered <br />❑ Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible E PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />08/31/2015 <br />ADJ HIRE DATE <br />11/16/2015 <br />POSITION DATE <br />11/16/2015 <br />LAST RAISE DATE <br />15.00 <br />BASE WAGE <br />$2923.00 <br />$ <br />LONGEVITY <br />$ <br />$ <br />FTE <br />E 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />E 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$2923.00 <br />$15.00 <br />PAYMENT METHOD <br />❑ HOURLY E MONTHLY <br />® HOURLY ❑ MONTHLY <br />DEPARTMENT <br />SHERIFF <br />BUDGET NUMBER <br />A.001300151001 %:100 <br />B. %: <br />A.01300251003 %:-100 <br />B. %: <br />WORKWEEK <br />E Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />E Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, <br />or other, it must be listed in both columns for audit purposes or the amount will default to '0". <br />ALLOWANCE (Detail in Comments Section) $0 $ <br />STIPEND (Detail in Comments Section) <br />$0 $ <br />OTHER (Detail in Comments Section) <br />$0 $ <br />SECTION 4: SIGNATURES (MUST <br />BE SIGNED IN BLUE INK) <br />DEPARTMENT / OFFICIAL <br />DATE <br />BUDGET/PAYRO ATE <br />54 <br />HUN OURCE <br />DATE <br />COMM 10 # �� /� ATE <br />U <br />COMM[ 1017 <br />DATE <br />COMPMI 77 <br />[� ".GV <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: <br />NT Update Eval Date Eval Rating (IE— ID — S —AA — S) Initial <br />y <br />