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le�� KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />MacKenzie <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Diana M0069 01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />❑✓ 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: Increase per wage survey - payment effective 1/1/17; deferred until February payroll. <br />SECTION 3: POSITION DATA <br />Enter exlsting data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />DISTRICT COURT ADMIN <br />OCCUPATION CODE <br />1310 <br />UNION CODE <br />30 <br />PAY GRADE <br />110 <br />STEP /_POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt Il Exempt ❑ Not Covered <br />❑ Non -Exempt 0 Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible 0 PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible Il PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />12/3/1984 <br />ADJ HIRE DATE <br />12/3/1984 <br />POSITION DATE <br />9/1/2010 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$4,377.00 <br />$5,409.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑p 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />p 100% ❑ 80% ❑ 75% ❑ 60% [150% <br />FTE WAGE <br />$4,377.00 <br />$5,409.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY 0 MONTHLY <br />DEPARTMENT <br />UPPER DISTRICT COURT <br />BUDGET NUMBER <br />A. 001 000000000003251001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />Il Standard ❑ ALT/I" Friday off: ❑ 207(k) <br />Il Standard ❑ ALT/I" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, or other, it must be listed in both columns for audit purposes or the amount will default to '0". <br />ALLOWANCE (Detail in Comments Section) <br />$ 0.00 <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 SIG IN BLUE INK) <br />DEPARTMENT HEAD/ ELECTED OFFICIAL DATE <br />BUDGET/ YROL DTE <br />4}MAN RESOURCE <br />DATE <br />COM R DATE <br />C 2 <br />DATf <br />1 4A. <br />COM SIGN . f ATE <br />.Z <br />ETURNRFORM TO HESOUR0.1011 DISTRI TION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eva[ Rating (IE—ID—S—AA—S) Initial <br />