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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Hansen <br />EMPLOYEE TYPE <br />LJ 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 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Doc H2334 09/19/2016 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE ACTION TYPE OF SEPARATION I REASON FOR SEPARATION <br />U 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 LJ Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: Remove Interim Stipend <br />upon hire of new CDS Director. <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />PLANNING OFFICIAL <br />OCCUPATION CODE <br />2397 <br />UNION CODE <br />30 <br />PAY GRADE <br />297 <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 0 PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />11112012 <br />ADJ HIRE DATE <br />1/1/2012 <br />POSITION DATE <br />11112012 <br />LAST RAISE DATE <br />1/1,12016 <br />BASE WAGE <br />$ 6,186.00 <br />$ 0.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />0 l00% ❑ 8o% ❑ 7S% [160% ❑ 50% <br />100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 6,186.00 <br />$ <br />PAYMENT METHOD <br />❑ HOURLY ❑' MONTHLY <br />❑ HOURLY [] MONTHLY <br />DEPARTMENT <br />COMMUNITY DEVELOPMENT SERVICES <br />BUDGET NUMBER <br />A. 402 000000204211051001 %: 10.00 <br />B. %: <br />A. W <br />B. W <br />WORKWEEK <br />E] Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />[j] 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) $ 0,00 $ 0.00 <br />STIPEND (Detail in Comments Section) <br />$ 750.00 $ 0,00 <br />OTHER (Detail in Comments Section) <br />1 $ 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 />HWMAN ESOURCE <br />j DATE <br />CO I ✓ DATE <br />COl�tg(( {8 ER H2 I,� <br />\�.� � <br />DATE ` <br />A W <br />CCIgIIGII i,� #3 DATE <br />s��2 ' —3 <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 />