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LAST NAME <br />Odiaga <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # FEFFECTIVE DATE <br />Katie 02722 01 /E(01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />V[I ULL-TI ME (1) <br />❑ PART-TIME (2) <br />❑ NEW HIRE <br />❑ RE -HIRE <br />❑ DISCHARGE (D) <br />❑ RESIGNATION (Q) <br />❑ PERFORMANCE (P) <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 />ADJ HIRE DATE <br />8/15/2016 <br />❑ Eligible For Rehire ❑ Ineligible For Rehire <br />❑ WORK STUDY (8) <br />OTHER (Describe Below) <br />i Provide Details of Separation Below <br />❑ VOLUNTEER (9) <br />COMMENTS: Increase per wage survey -payment effective 1/1/17; deferred until February payroll. <br />SFCTION a! POSITION DATA <br />To continue any allowance, stipend, or other, it must be listed in both columns for audit purposes or the amount will aefoult to "u". <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 SIGNED IN BLUE INK) <br />HUMAN RESOURCE DATE <br />Ca-, I 111, �--� �L I2 <br />�= RETURN FORM TO HUMAN RESOURCES FOR DIS' <br />Updated: 04/08/11 FOR HR USE: NT Update Eva[ Date <br />ATE <br />Eval Rating (IE—ID—S—AA—S) Initial <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />PUBLIC HEALTH TECHNICIAN <br />OCCUPATION CODE <br />3412 <br />UNION CODE <br />40 <br />PAY GRADE <br />312 <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 />8/15/2016 <br />ADJ HIRE DATE <br />8/15/2016 <br />POSITION DATE <br />8/15/2016 <br />LAST RAISE DATE <br />I <br />BASE WAGE <br />$ 2,946.00 <br />$ 3,583.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑O 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />[j] 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 2,946.00 <br />$ 3,583.00 <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. 56t <br />A. %: <br />B. %: <br />WORKWEEK <br />E] Standard ❑ ALT/1A 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 aefoult to "u". <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 SIGNED IN BLUE INK) <br />HUMAN RESOURCE DATE <br />Ca-, I 111, �--� �L I2 <br />�= RETURN FORM TO HUMAN RESOURCES FOR DIS' <br />Updated: 04/08/11 FOR HR USE: NT Update Eva[ Date <br />ATE <br />Eval Rating (IE—ID—S—AA—S) Initial <br />