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U <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 />GANN <br />FIRST NAME <br />Sarah <br />EMPLOYEE # <br />G2721 <br />EFFECTIVE DATE <br />02/21/17 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION 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: Sarah Gann will be taking over the disability board duties that were formerly handled by Kim Nuffer (who has <br />transferred to the Prosecutor's office). <br />SECTION 3: POSITION DATA <br />Enter existing datafrom CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />U C r <br />OCCUPATION CODE <br />4 �� <br />UNION CODE <br />PAY GRADE <br />Cj <br />STEP / POSITION <br />FLSA STATUS <br />Non -Exempt ❑ Exempt ❑ Not Covered <br />Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible 03PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible N PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />1E) <br />ADJ HIRE DATE <br />S 51 <br />POSITION DATE <br />LAST RAISE DATE <br />BASE WAGE <br />$ 3 <br />$ <br />LONGEVITY <br />$ 0 <br />$ <br />FTE <br />X 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />R 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ M%3 <br />$ <br />PAYMENT METHOD <br />❑ HOURLY [% MONTHLY <br />❑ HOURLY [)fl MONTHLY <br />DEPARTMENT <br />CI I e, f 1<, <br />BUDGET NUMBER <br />A.0010000159951001 %: 100 <br />B. r: <br />A.001000159951001 %: 62 <br />B. 00 100000 195 1001 %:38 <br />WORKWEEK <br />5l Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />X 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) <br />$ 0 $ <br />STIPEND (Detail in Comments Section) <br />$ $ <br />OTHER (Detail in Comments Section) <br />$ (j $ <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />DEPART HELECTED OFFIL) <br />,7 <br />BUDGETjPY <br />,� /, <br />HU AN RESOURCE <br />DATE -7 <br />1 <br />COMltiRi O DATE <br />COM=3—sle pAi <br />:1le .00 <br />C MI 11 <br />DATE <br />RETURN FORM TO HUMAN RESOURCES FOR DI IEiUTION. <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE— ID—S—AA—S) Initial <br />