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C+ _ <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Blackford <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Candi B2058 1/1/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />❑� FULL-TIME (1) ❑ NEW HIRE ❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />❑ PART-TIME (2) ❑ RE -HIRE ❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ LIMITED PART-TIME (3) ❑ MERIT/ STEP ❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ TEMPORARY (4) ❑ POSITION CHANGE (Describe Below) ❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ CASUAL (5) ❑ BUDGET CHANGE (Describe Below) ❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ SEASONAL (6) ❑ LEAVE (List Type Below) ❑ OTHER (0) ❑ OTHER (0) <br />❑ PROJECT (7) ❑ TERMINATION (Provide Separation Info) <br />❑ WORK STUDY (8) OTHER (Describe Below) ❑ Eligible For Rehire ❑ Ineligible For Rehire <br />❑ VOLUNTEER (9) 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 />ADMINSTRATIVE SUPERVISOR <br />OCCUPATION CODE <br />3349 <br />UNION CODE <br />30 <br />PAY GRADE <br />349 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt Ij Exempt ❑ Not Covered <br />❑ Non -Exempt 0 Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible 0 PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible Q PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />3/10/2008 <br />ADJ HIRE DATE <br />3/10/2008 <br />POSITION DATE <br />7/13/2015 <br />LAST RAISE DATE <br />1/1/2015 <br />BASE WAGE <br />$ 3,692.00 <br />$ 3,877.00 <br />LONGEVITY <br />$ 0.00 <br />{ $ <br />FTE <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />❑' 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 3,692.00 <br />$ 3,877.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY ❑� MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. 116 000000000061151001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />Q Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />M 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 <br />BE SIGNET] UE INK) <br />M EAb•/.ELE D OFFICIAL <br />DATE <br />BUDGET/PAYR LL ' AT, <br />HUMAN RESOURCE <br />DATECOMMI5 <br />p ATE <br />C E 2 <br />DATE <br />tor® <br />LOM N6HPS' DAT151 <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated 04/08/11 FOR HR USE: <br />NT Update EvalDate EvalRating(IE—ID—S—AA—S) Initial <br />