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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />NELSON MARK N0378 8/23/16 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE EMPLOYEE ACTION TYPE OF SEPARATION REASON FOR SEPARATION <br />E) J FULL-TIME (1) ❑ NEW HIRE ❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />❑ PART-TIME (2) ® RE -HIRE ❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ LIMITED PART-TIME (3) ❑ MERIT/ STEP ❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ TEMPORARY (4) ❑ POSITION CHANGE (Describe Below) ❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ CASUAL (5) ❑ BUDGET CHANGE (Describe Below) ❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ SEASONAL (6) ❑ LEAVE (List Type Below) ❑ OTHER (0) ❑ OTHER (0) <br />® PROJECT (7) ❑ TERMINATION (Provide Separation Info) <br />❑ WORK STUDY (8) ❑ OTHER (Describe Below) ❑ Eligible For Rehire ❑ Ineligible For Rehire <br />❑ VOLUNTEER (9) Provide Details of Separation Below <br />COMMENTS: Pro'ect Specialist to fill in for current employee out on leave; focus on OSS program. Non -benefitted; position <br />expires on 1 <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />Project Specialist <br />OCCUPATION CODE <br />_ <br />3874 <br />UNION CODE <br />87 <br />374 <br />PAY GRADE <br />STEP / POSITION <br />8 <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 />08/23/16 <br />ADJ HIRE DATE <br />08/23/16 <br />POSITION DATE <br />08/23/16 <br />LAST RAISE DATE <br />BASE WAGE <br />$ <br />$27.00/hr <br />LONGEVITY <br />$ <br />$0 <br />FTE <br />❑ 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />® 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ <br />$27.00/hr <br />PAYMENT METHOD <br />❑ HOURLY ❑ MONTHLY <br />® HOURLY ❑ MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. %: <br />B. %: <br />A. % <br />B. %: <br />WORKWEEK <br />❑ Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />® Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, 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 BE SIGNED IN qj&E INK) <br />DEPARTMENT HEAD/ ELECTED OFFICIAL <br />DATE <br />BUDGET/PAYROLL AE <br />22 O <br />HUMgNE U <br />DATE <br />M E DATE <br />COMMISSIONER J �J <br />DATE <br />r AW&SSh{O7if(E/�r#3 l ^(DATE <br />L'C/�� r/ <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date EvalRating(IE– ID–S–AA–S) Initial— <br />