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C� <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Caulkins <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # <br />Neil C1755 11-1-17 <br />EFFECTIVE DATE <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) <br />❑ RESIGNATION (Q) <br />❑ RETIRED (R) <br />❑ LAID OFF (L) <br />❑ FAIL PROBATION (P) <br />❑ OTHER (0) <br />❑ PERFORMANCE (P) <br />❑ ATTENDANCE (A) <br />❑ CONDUCT (C) <br />❑ OTHER EMPLOYMENT (E) <br />❑ PERSONAL (L) <br />❑ OTHER (0) <br />❑ Eligible For Rehire ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: Increase per wage survey- effective 1-1-17; deferred until February payroll <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />DPA III <br />OCCUPATION CODE <br />2317 <br />UNION CODE <br />30 <br />PAY GRADE <br />217 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt ® Exempt ❑ Not Covered <br />❑ Non -Exempt qExempt <br />❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ® PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible NPERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />8-15-05 <br />ADJ HIRE DATE <br />8-15-05 <br />POSITION DATE <br />8-15-05 <br />LAST RAISE DATE <br />1-1-16 <br />1-1-17 <br />BASE WAGE <br />$7128. <br />$7434. <br />LONGEVITY <br />$0 <br />$ <br />FTE <br />® 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />R) 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$7128 <br />$7434. <br />PAYMENT METHOD <br />❑ HOURLY ® MONTHLY <br />[]HOURLY 1)4 MONTHLY <br />DEPARTMENT <br />Prosecutor <br />BUDGET NUMBER <br />A.001290351001 %:100 <br />B. %: <br />A. <br />B. <br />%: <br />%: <br />WORKWEEK <br />® Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />❑ Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, <br />or other, it must be listed in both columns for audit purposes or the amount will default to 1011. <br />ALLOWANCE (Detail in Comments Section) <br />$0 $ <br />STIPEND (Detail in Comments Section) <br />$0 $ <br />OTHER (Detail in Comments Section) <br />$0 $ <br />SECTION 4: SIGNATURES (MUST BE SIWD IN BLUE INK) <br />DEPARTME D I EtECTED60,116,4L <br />f . - DATE <br />BUDGETIPAYR. LL <br />DATE <br />HMAN,8 OURCE <br />DATE <br />COMIVII <br />T <br />Co <br />2ATE COM _ <br />1.3 <br />RETURN FORM TO HUMAN RESOD S FOR DISTRI9U71ON <br />C1 <br />Updated: 04/08/11 FOR HR USE: NT Update EvalDate EvalRating(IE— ID—S—AA—S) Initial <br />