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QA <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update EvalDate Eval Rating (IE—ID—S—AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Jurgens <br />FIRST NAME <br />Kathy <br />EMPLOYEE # <br />J0040 <br />EFFECTIVE DATE <br />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 />El PART-TIME (3)I�FP <br />❑ TEMPORARY (4) <br />❑ CASUAL (S) <br />❑ SEASONAL (6) <br />❑ PROJECT (7) <br />❑ WORK STUDY (8) <br />❑ VOLUNTEER (9) <br />❑ NEW HIRE <br />❑ RE -HIRE <br />❑ POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />TERMINATION (Provide Separation Info) <br />THER (Describe Below) <br />t <br />❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />E 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 01/01/17; deferred until February payroll. Interim -stipend to continue until <br />March 1st. <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />FINANCE SYSTEM MANAGER <br />OCCUPATION CODE <br />2362 <br />UNION CODE <br />30 <br />PAY GRADE <br />262 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />E Non -Exempt ❑� Exempt ❑ Not Covered <br />❑ Non -Exempt ❑� Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible 0 PERS ❑ LEOFF E PSERS E Other <br />❑ Ineligible El PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />8/20/1979 <br />ADJ HIRE DATE <br />8/20/1979 <br />POSITION DATE <br />11/13/1992 <br />LAST RAISE DATE <br />1/1/2016 <br />I 1 <br />BASE WAGE <br />$ 5,692.00 <br />$ 6,261.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />0100% El ❑ 75% ❑ 60% ❑ SO% <br />E 100% E 80% E 75% E 60% ❑ 50% <br />FTE WAGE <br />$ 5,692.00 <br />$ 6,261.00 <br />PAYMENT METHOD <br />❑ HOURLY E� MONTHLY <br />E HOURLY ❑� MONTHLY <br />DEPARTMENT <br />PUBLIC WORKS <br />BUDGET NUMBER <br />A. 000 RA3376 %: 100.00 <br />B. -%: <br />A. %.- <br />B. %: <br />:s. <br />WORKWEEK <br />0 Standard ❑ ALT/1" Friday off: _E3207(k) <br />El 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 />$ 500.00 S , Q <br />OTHER (Detail in Comments Section) <br />$ 0.00 $ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />q PARTMENT HEAD / ELECTED OFF CIAt DATE <br />Wvt-- <br />BUDGET/ YROL D. TE <br />H A <br />I DATE <br />COM MI 1 DAT <br />C!—m <br />DAF <br />'2 <br />I . t <br />CONI N A <br />/ <br />RETURN FORM TO HUMAN RESOUR ES FOR DISTRIBUTrON <br />Updated: 04/08/11 FOR HR USE: NT Update EvalDate Eval Rating (IE—ID—S—AA—S) Initial <br />