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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />CARLSON <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />DANIEL "DAN" C2724 09/19/16 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />Q9 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 />COMMENTS: <br />EMPLOYEE ACTION TYPE OF SEPARATION REASON FOR SEPARATION <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 />❑ OTHER (Describe Below) ❑ Eligible For Rehire ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />_ <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report Enter new data <br />JOB TITLE <br />CDS DIRECTOR <br />OCCUPATION CODE <br />1303 <br />UNION CODE <br />30 <br />PAY GRADE <br />103 <br />5 <br />STEP / POSITION <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 />09/19/16 <br />ADJ HIRE DATE <br />09/19/16 <br />POSITION DATE <br />09/19/16 <br />LAST RAISE DATE <br />BASE WAGE <br />$ <br />$6677 <br />LONGEVITY <br />$ <br />$O <br />FTE <br />❑ 100% [:]80% E]75% ❑ 60% ❑ 50% <br />[D 100% E]80% [:]75 '0 E_60% ❑ 509 <br />FTE WAGE <br />$ <br />$6677 <br />PAYMENT METHOD <br />❑ HOURLY ❑ MONTHLY <br />❑ HOURLY ® MONTHLY <br />DEPARTMENT <br />CDS <br />BUDGET NUMBER <br />A. is <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 BLUE INK) <br />DEPARTMENT HEAD / ELECTED OFFICIAL <br />DATE <br />BUDGET/PAYROI"-'�E <br />HVMAN RESOURCE <br />CO ER <br />DATE <br />DATEC� <br />CO I V DATE <br />IVf MI5MS# `DATE <br />�-� "t->- <br />RETURN FORM TO HUMAN RESOURCES <br />FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date EvalRating(IE- ID -S -AA -S) Initial <br />