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j <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Whitaker <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Liz W1482 01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />❑Q 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 />❑r 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 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 />COMMUNITY HEALTH SPVR <br />OCCUPATION CODE <br />2393 <br />UNION CODE <br />30 <br />PAY GRADE <br />293 <br />STEP / POSITION <br />1 <br />FLSA STATUS <br />❑ Non -Exempt ❑� Exempt ❑ Not Covered <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 />9/10/2012 <br />ADJ HIRE DATE <br />9/10/2012 <br />POSITION DATE <br />9/10/2012 <br />LAST RAISE DATE <br />1/1/2016 <br />l 1 <br />BASE WAGE <br />$ 5,253.00 <br />$ 5,673.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% [150% <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 5,253.00 <br />$ 5,673.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY ❑' MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. 116 000000000061251001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />❑' Standard ❑ ALT/1" 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) $ 0,00 $ 0.00 <br />STIPEND (Detail in Comments Section) $ 0.00 $ 0.00 <br />OTHER (Detail In Comments Section) <br />$ 0.00 $ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />DE T#AENTIREY{�� E OF ICTAL L� + I 1 DATE <br />14 <br />BUDGET/PAY LL ATE <br />'fes <br />MAN RESOURCE <br />DATE <br />COM I DATE <br />CO 4 • ATE <br />02- -13 <br />C <br />DATE <br />2.1 t-15- <br />RETURN FORM TO HUMAN RESOURCES FOR nicTiaftyfioN <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date EvalRating(IE—ID—S—AA—S) Initial <br />