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C-,� <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE—ID—S—AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Larson <br />FIRST NAME <br />Mark <br />EMPLOYEE # <br />L1866 <br />EFFECTIVE DATE <br />01/01/2017 <br />SECTION 2: TYPE OF ACTION _ <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />I TYPE OF SEPARATION 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 />❑ MERIT/ STEP <br />❑ POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />❑ TERMINATION (Provide Separation Info) <br />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 Enter new data <br />JOB TITLE <br />OCCUPATION CODE <br />HEALTH OFFICER <br />1351 <br />UNION CODE <br />32 <br />PAY GRADE <br />151 <br />STEP / POSITION <br />1 <br />FLSA STATUS <br />❑ Non -Exempt [:]Exempt ❑ Not Covered ❑ Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />E Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other ❑� Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />7/1/2006 <br />ADJ HIRE DATE <br />7/1/2006 <br />POSITION DATE <br />7/1/2006 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$ 2,941.60 $ 3,276.00 <br />LONGEVITY <br />$ 0.00 $ <br />FTE <br />❑ 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% ❑ 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$14,708.00 $ 0.00 l b s o <br />PAYMENT METHOD <br />❑ HOURLY Q MONTHLY ❑ HOURLY ❑' MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. 116 000000000061551011 %: 50.00 A. %: <br />B. 116 000000000061251011 %: 25.00 B. %: <br />WORKWEEK <br />Standard ❑ ALT/1" Friday off: ❑ 207(k) '❑ 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 />AL <br />�)-[ ( <br />ZMM= <br />DATE <br />I l <br />BUDGET/P RUt DATE <br />2I,l. <br />HUMAN RESOURCE <br />DATE <br />C r] <br />/ <br />COMMIS DA TE <br />ryR <br />DATE <br />COM Oid t <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE—ID—S—AA—S) Initial <br />