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C_� <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE—ID—S—AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Bloxham <br />FIRST NAME EMPLOYEE # <br />Christina B2659 <br />EFFECTIVE DATE <br />12/01/2016 <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 />❑LIMITE DPART-TI ME(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: Employee annual evaluation has been completed. Effective date is 12/01/16 - Step 2 $3,700.; January 1, 2017 $3,811. <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />FISCAL ANALYST - PW <br />OCCUPATION CODE <br />3213 <br />UNION CODE <br />20 <br />PAY GRADE <br />313 <br />STEP / POSITION <br />1 <br />2 <br />FLSA STATUS <br />❑' Non -Exempt ❑ Exempt ❑ Not Covered <br />❑' Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible PERS ❑LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible OaPERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />12/14/2015 <br />ADJ HIRE DATE <br />12/14/2015 <br />POSITION DATE <br />12/14/2015 <br />LAST RAISE DATE <br />12/01/2016 <br />BASE WAGE <br />$3,618.00 <br />$3,811.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑' 100% [:180% ❑ 75% ❑ 60% ❑ 50% <br />❑' 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 3,618.00 <br />$ 3,811.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑' MONTHLY <br />❑ HOURLY ❑' MONTHLY <br />DEPARTMENT <br />PUBLIC WORKS <br />PUBLIC WORKS <br />BUDGET NUMBER <br />A. 000 RA3376 %: 100.00 <br />B. 1W <br />A. %: <br />B. %: <br />WORKWEEK <br />0 Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />0 Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, or other, it must be listed in both columns foroudit 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 />$ 0,00 $ 0.00 <br />OTHER (Detail in Comments Section) <br />$ 0.00 $ 0.00 <br />SECTION 4: SIGNATURES MUST BE SIGNE i LUE INK) <br />DEA TMENT HEAD / E TEF} OFFIC <br />DATE <br />]BUDGETJpAY OLL PATE <br />M RES RCE <br />4r <br />DAT <br />COMM1 DATE <br />Co. R 2 <br />DATE <br />COMM N A <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 />