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r-. KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Harwood <br />_SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Shannon H1601 1-1-17 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <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 />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <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: y <br />Q <br />1 Ati7Jv1 PIL +D TvY✓, P&v�'� 1.1— <br />9 (� <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />Crime Victim Specialist <br />OCCUPATION CODE <br />2453 <br />UNION CODE <br />40 <br />PAY GRADE <br />253 <br />STEP / POSITION <br />5 <br />® Non -Exempt [_-]Exempt ❑Not Covered <br />FLSA STATUS <br />❑ Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ® PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />5-17-04 <br />ADJ HIRE DATE <br />5-17-04 <br />POSITION DATE <br />8-9-04 <br />LAST RAISE DATE <br />1-1-16 <br />1-1-17 <br />BASE WAGE <br />$3770 <br />$4147. <br />LONGEVITY <br />$0 <br />$ <br />FTE <br />® 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />❑ 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$3770 <br />$4147 <br />PAYMENT METHOD <br />❑ HOURLY ® MONTHLY <br />❑ HOURLY ❑ MONTHLY <br />DEPARTMENT <br />Prosecutor <br />BUDGET NUMBER <br />A.13O51OO1 %:70 <br />B. 130290551001 %:30 <br />A. %: <br />B. %: <br />WORKWEEK <br />®Standard ❑ALT/V Friday off: ❑ 207(k) <br />❑Standard ❑ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, or other, it must be listed in both columns for audit purposes or the amount will default to "0". <br />ALLOWANCE (Detail in Comments Section) <br />$ <br />$ <br />STIPEND (Detail in Comments Section) <br />$ <br />$ <br />OTHER (Detail in Comments Section) <br />$ <br />$ <br />SE 4: SIGNATURES (MUST BE SIGNED IN BLUE TN K) <br />DEP ME EAD / EtECTF 1CIAL <br />^� ' DATE <br />BUD.GETIP 04? T' <br />HUM <br />116- M7 /,A: !' <br />DATE <br />V-7 <br />CO SS ONE DAT <br />CO M R 2 <br />CO ATf <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date EvalRating(IE- ID -S -AA -S) Initial <br />