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KITTITAS COUNTY PERSONNEL ACTION FORM (PAFI <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date EvalRating(IE—ID—S —AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Hodges <br />FIRST NAME <br />Karen <br />EMPLOYEE # EFFECTIVE DATE <br />H2715 01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />❑✓ FULL-TIME (1) <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 />J'$TPP <br />❑ POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />ERMINATION (Provide Separation Info) <br />ER (Describe Below) <br />❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ OTHER (0) ❑ OTHER (0) <br />❑ Eli ible For Rehire <br />g' ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: Increase per wage survey - payment effective 1/1/17; deferred until February payroll. <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />PLANNER III <br />OCCUPATION CODE <br />2492 <br />UNION CODE <br />40 <br />PAY GRADE <br />292 <br />STEP /POSITION <br />6 <br />FLSA STATUS <br />❑' Non -Exempt ElExempt [:1p Not Covered <br />❑� Non -Exempt ❑ Exempt ❑Not Covered <br />DRS STATUS <br />❑ Ineligible [j) PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible El PERS ❑ LEOFF [I PSERS ❑ Other <br />HIRE DATE <br />7/11/2016 <br />ADJ HIRE DATE <br />7/11/2016 <br />POSITION DATE <br />7/11/2016 <br />LAST RAISE DATE <br />BASE WAGE <br />$ 5,000.00 <br />$5,�va.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />EE l00% ❑ 8or ❑ 75% ❑ 60% ❑ 50% <br />F!] 100% ❑ 80% [175% ❑ 60 ❑ 50% <br />FTE WAGE <br />$ 5,000.00 <br />$ 5,500.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY ❑� MONTHLY <br />DEPARTMENT <br />PUBLIC WORKS <br />BUDGET NUMBER <br />A. 000 RA3376 %: 100.00 <br />B. 000 RA3376 is 100.00 <br />A. %: <br />B. %: <br />WORKWEEK <br />0 Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />[E 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 />$ 0.00 $ 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 BE S] ED IN BLUE INK) <br />AER,ARTMENTHEAD/TED OFFICI I. <br />`► �vus4Lla <br />DATE <br />N b O 1 o ai 0.1`1 <br />BUDGE /PAY Lk 7E <br />A' , ori <br />MA RE U £ <br />DATE <br />COMMIS$ 91. DA <br />C R <br />DA7T <br />COMM11W.ER,% p E <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 />