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Ok <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 />Bacon <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Kelly B1480 1/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />Q FULL-TIME (1) <br />❑ PART-TIME (2) <br />❑ LIMITED PART-TIME (3) <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 />-®-lvf M17STEP <br />❑ POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />QJERMINATION (Provide Separation Info) <br />91THFR (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 existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />ENGINEER TECHNICIAN I <br />OCCUPATION CODE <br />2425 <br />UNION CODE <br />40 <br />PAY GRADE <br />225 <br />STEP / POSITION <br />6 <br />FLSA STATUS <br />E Non -Exempt ❑ Exempt ❑ Not Covered <br />Q Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible [j] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible [j] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />7/5/2002 <br />ADJ HIRE DATE <br />7/5/2002 <br />POSITION DATE <br />6/25/2007 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$ 3,631.00 <br />$ 4,428.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />0 100% ❑ 80% ❑ 7s% ❑ 60% ❑ so% <br />p l00% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 3,631.00 <br />$ 4,428.00 <br />PAYMENT METHOD <br />❑ HOURLY Q MONTHLY <br />❑ HOURLY Q MONTHLY <br />DEPARTMENT <br />PUBLIC WORKS <br />BUDGET NUMBER <br />A. 000 RA3376 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />[j] 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 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 />$ 0.00 $ 0.00 <br />OTHER (Detail in Comments Section) <br />$ 0.00 $ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK <br />TP RTMENT HEAD E LTE D.0FFICIAL <br />[: <br />DATE <br />LkA P 01 --AID i <br />BUDGETJPA DATE <br />.2 <br />I MA RE OURCE <br />DATE <br />COMMIS DA <br />O CR #2 I <br />Co" <br />TE <br />COM q F <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 />