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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update Eva[Date EvalRating(IE—ID—S—AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Cook <br />FIRST NAME <br />Mark <br />EMPLOYEE # EFFECTIVE DATE <br />C2618 11/01/2015 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION REASON FOR SEPARATION <br />LTJ 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 />❑ 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) ❑ PERFORMANCE (P) <br />❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ OTHER (0) ❑ OTHER (0) <br />❑ Eligible For Rehire ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: Replaces PAF previously <br />submitted for increase upon successful six months. <br />SECTION 3: POSITION DATA <br />Enterexisting data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />PUBLIC WORKS DIRECTOR <br />OCCUPATION CODE <br />1318 <br />UNION CODE <br />30 <br />PAY GRADE <br />118 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt ❑� Exempt ❑ Not Covered <br />❑ Non -Exempt ❑� Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑' PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />5/4/2015 <br />ADJ HIRE DATE <br />5/4/2015 <br />POSITION DATE <br />5/4/2015 <br />LAST RAISE DATE <br />11/4/2015 <br />BASE WAGE <br />$ 7,700.00 <br />$ 7,800.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />El 100% ❑ 80% [-175% ❑ 60% ❑ 50% <br />p 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 7,700.00 <br />$ 7,800.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑' MONTHLY <br />❑ HOURLY ❑� MONTHLY <br />DEPARTMENT <br />PUBLIC WORKS <br />BUDGET NUMBER <br />A. 000 RA3376 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />j 0 Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />Q 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) <br />$ 0.00 <br />$ 0.00 <br />STIPEND (Detail in Comments Section) <br />$ 0.00 <br />$ 0.00 <br />OTHER (Detail in Comments Section) <br />$ 0.00 <br />$ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK <br />DEPARTMENT HEAD / ELECTED OFFICIAL <br />DATE <br />BUDMkOLL DATE <br />H MN SOURCE <br />DATE <br />COMMISSIONER l a DATE <br />COMMIS R #2j <br />--jJ_%/ <br />DATE COMMISSI # DATE <br />2 ��� <br />RETURN FORKA TOfiLlMAN RESOURCES FOR DISTRIBUTION`' <br />Updated: 04/08/11 FOR HR USE: NT Update Eva[Date EvalRating(IE—ID—S—AA—S) Initial <br />