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GA- <br />LAST NAME <br />Larson <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Chad I L2667 �' <br />SECTION 2: TYPE OF ACTION 4_1 <br />!-1 <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />❑✓ FULL-TIME (1) <br />❑ NEW HIRE <br />❑ DISCHARGE (D) <br />❑ PERFORMANCE (P) <br />❑ PART-TIME (2) <br />❑ RE -HIRE <br />❑ RESIGNATION (Q) <br />❑ ATTENDANCE (A) <br />❑ LIMITED PART-TIME (3) <br />MERIT / STEP <br />❑ RETIRED (R) <br />❑ CONDUCT (C) <br />❑ TEMPORARY (4) <br />❑ POSITION CHANGE (Describe Below) <br />❑• LAID OFF (L) <br />❑ OTHER EMPLOYMENT (E) <br />❑ CASUAL (5) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ FAIL PROBATION (P) <br />❑ PERSONAL (L) <br />❑ SEASONAL (6) <br />❑ LEAVE (List Type Below) <br />❑ OTHER (0) <br />❑ OTHER (0) <br />❑ PROJECT (7) <br />❑ TERMINATION (Provide Separation Info) <br />02/02/2017 <br />LAST RAISE DATE <br />❑ WORK STUDY (8) <br />❑ OTHER (Describe Below) <br />❑ Eligible For Rehire ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />❑ VOLUNTEER (9) <br />COMMENTS: CHAD IS MOVING TO APPRAISER II, STEP 1 UPON SUCCESSFUL COMPLETION OF REQUIREMENTS; DATE OF <br />ACCREDITATION 02/02/2017 <br />SECTION 3: POSITION DATA <br />BASE WAGE $ 3,746.00 $ 3,936.00 <br />LONGEVITY $ 0.00 $ 0 <br />FTE 0 100% ❑ 80% ❑ 75% [:160% ❑50% 0 100% [:180% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE $ 3,746.00 $ 3,936.00 <br />PAYMENT METHOD ❑ HOURLY ❑• MONTHLY ❑ HOURLY Q MONTHLY <br />DEPARTMENT ASSESSOR <br />BUDGET NUMBER A. 142 000000000001451001 %: 50.00 A %: <br />B. 001 000000000001051001 %: 50.00 g, [dC�� �..�A,�� %: <br />WORKWEEK E Standard ❑ ALT/1" Friday off: ❑ 207(k) Q 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) $ 0.00 $ 0,00 <br />OTHER (Detail in Comments Section) $ 0,00 $ 0,00 <br />SECTION 4: SIGNATURES (MUST BE SIGN BLUE INK) <br />DEPA %iNIENT HEAD /.ELECTED OFF1 AL DATE BUDGE�PA OLL DATE <br />HUMA RESOURCE / DATE I COMVISS"Eflff HATE <br />�I!��'�� 7L�ila /��it�J•!i=1f��• _r�� �T� ��1aI1l�i <br />Updated: 04/08/11 FOR HR USE: <br />NT Update Eval Date EvalRating(IE–ID–S–AA–S) Initial <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />APPRAISER I <br />APPRAISER II <br />OCCUPATION CODE <br />2159 <br />2166 <br />UNION CODE <br />10 <br />to <br />PAY GRADE <br />259 <br />266 <br />STEP / POSITION <br />1 <br />FLSA STATUS <br />E• Non -Exempt ❑ Exempt ❑ Not Covered <br />❑• Nan -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible N PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ IneligibleZ 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 />02/02/2017 <br />LAST RAISE DATE <br />02/02/201 <br />BASE WAGE $ 3,746.00 $ 3,936.00 <br />LONGEVITY $ 0.00 $ 0 <br />FTE 0 100% ❑ 80% ❑ 75% [:160% ❑50% 0 100% [:180% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE $ 3,746.00 $ 3,936.00 <br />PAYMENT METHOD ❑ HOURLY ❑• MONTHLY ❑ HOURLY Q MONTHLY <br />DEPARTMENT ASSESSOR <br />BUDGET NUMBER A. 142 000000000001451001 %: 50.00 A %: <br />B. 001 000000000001051001 %: 50.00 g, [dC�� �..�A,�� %: <br />WORKWEEK E Standard ❑ ALT/1" Friday off: ❑ 207(k) Q 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) $ 0.00 $ 0,00 <br />OTHER (Detail in Comments Section) $ 0,00 $ 0,00 <br />SECTION 4: SIGNATURES (MUST BE SIGN BLUE INK) <br />DEPA %iNIENT HEAD /.ELECTED OFF1 AL DATE BUDGE�PA OLL DATE <br />HUMA RESOURCE / DATE I COMVISS"Eflff HATE <br />�I!��'�� 7L�ila /��it�J•!i=1f��• _r�� �T� ��1aI1l�i <br />Updated: 04/08/11 FOR HR USE: <br />NT Update Eval Date EvalRating(IE–ID–S–AA–S) Initial <br />