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. 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 />Larson <br />FIRST NAME <br />Chad <br />EMPLOYEE # <br />L2667 <br />EFFECTIVE DATE <br />01/01/2017 <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: Budget change due to Assessor's salary survey results. Changing budget allocation from 50% General Fund / 50% REET <br />to 43% General Fund / 57% REET, <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />APPRAISER I <br />OCCUPATION CODE <br />2159 <br />UNION CODE <br />10 <br />PAY GRADE <br />259 <br />STEP / POSITION <br />1 <br />FLSA STATUS <br />❑� Non -Exempt ❑ Exempt ❑ Not Covered <br />0 Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />2/2/2016 <br />ADJ HIRE DATE <br />2/2/2016 <br />POSITION DATE <br />2/2/2016 <br />LAST RAISE DATE <br />BASE WAGE <br />$3,746.00 <br />$0.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />0 100% ❑ 80% [:175% ❑ 60% ❑ 50% <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 3,746.00 <br />$ <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY 0 MONTHLY <br />DEPARTMENT <br />ASSESSOR <br />BUDGET NUMBER <br />A. 142 000000000001451001 %: 50.00 <br />B. 001000000000001051001 %:50.00 <br />A. 142 1451001 %: 57 <br />B. 0011051001 %:43 <br />WORKWEEK <br />0 Standard ❑ ALT/1" Friday off: ❑ 207(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) I $ 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 />SE l N 4: SIGNATURES (MUST BE SIGNED LUE INK) <br />DEP E T O/ELECTEDQFFI .A <br />lu <br />DATE <br />BUDGE TjPAY LL DA E J! <br />12 <br />U <br />JAAAU RESOURCE <br />DATE <br />COMN1155 ki DATE <br />i7h?in <br />C N <br />7 (DATE <br />COMM ! / TATE <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 />