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' KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />SECTION 1: EMPLOYFF DATA <br />LAST NAME <br />Flory <br />FIRST NAME <br />Mike <br />EMPLOYEE # I EFFECTIVE DATE <br />F1696 8/232016 <br />EMPLOYEE TYPE <br />u 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 />SECTION 2: TYPE OF ACTION <br />EMPLOYEE ACTION <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 />'TYPE OF SEPARATION REASON FOR SEPARATION <br />U 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 L) Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />PLANS EXAMINER <br />BUILDING OFFICIAL <br />OCCUPATION CODE <br />2443 <br />UNION CODE <br />40 <br />30 <br />PAY GRADE <br />243 <br />STEP / POSITION <br />8 <br />5 <br />FLSA STATUS <br />Q Non -Exempt ❑ Exempt ❑ Not Covered <br />❑ Non -Exempt 0 Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑' PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible E PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />2/22/2005 <br />ADJ HIRE DATE <br />2/22/2005 <br />POSITION DATE <br />2/22/2005 <br />08/23/2016 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$ 4,598.00 <br />$ 5,039.00 <br />LONGEVITY <br />$ 0.00 <br />$ 0 <br />FIFE <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />❑� 100% ❑ 80% [175% ❑ 60% ❑ SO% <br />FTE WAGE <br />$ 4,598.00 <br />$ 5,039.00 <br />PAYMENT METHOD <br />❑ HOURLY E MONTHLY <br />❑ HOURLY Q MONTHLY <br />DEPARTMENT <br />COMMUNITY DEVELOPMENT SERVICES <br />BUDGET NUMBER <br />A. 402 000001042020151001 %: 100.00 <br />B. %; <br />A. %: <br />B. %: <br />WORKWEEK <br />E] 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) <br />$ 0.00 $ 0.00 <br />STIPEND (Detail in Comments Section) <br />$ 250.00 $ 0.00 <br />OTHER (Detail in Comments Section) <br />$ 0,00 $ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />DEPARTMENT HEAD/ ELECTED OFFICIAL <br />DATE <br />BUDGET/PAYROLL TE <br />1�3// <br />HUfyL�N RES <br />{Vr� <br />RCE ' F <br />si"V�/✓✓�JJ <br />DATE„ ` <br />i <br />CO IS �ER/� / DATE <br />Y <br />CD iNElii #2 {r7 <br />DATE- <br />��,►� <br />CO fiR #3 'DATE <br />3_j, <br />�, Z✓ <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE — ID — S —AA —S) Initial <br />