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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Hodges <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # <br />Kelee H2567 <br />SECTION 2: TYPE OF ACTION <br />EFFECTIVE DATE <br />01/01/2017 <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 />[:1WORK STUDY (8) <br />❑ VOLUNTEER (9) <br />❑ NEW HIRE <br />❑ RE -HIRE <br />F2SjMt51TTMTEP <br />❑ POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />TERMINATION (Provide Separation Info) <br />THER (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 />ENGINEER TECHNICIAN I <br />OCCUPATION CODE <br />2425 <br />UNION CODE <br />40 <br />PAY GRADE <br />225 <br />STEP / POSITION <br />7 <br />FLSA STATUS <br />❑' Non -Exempt ❑ Exempt ❑ Not Covered <br />Q Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible 0 PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />7/18/2016 <br />ADJ HIRE DATE <br />7/18/2016 <br />POSITION DATE <br />7/18/2016 <br />LAST RAISE DATE <br />BASE WAGE <br />$ 3,417.00 <br />$3,M- .00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />El 100% ❑ 80% ❑ 7s% ❑ 60% ❑ so% <br />El l00% ❑ 80% <br />❑ 75% [:160% ❑ 50% <br />FTE WAGE <br />$ 3,417.00 <br />$ 3,817.00 <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. %: <br />A. <br />B. <br />%. <br />WORKWEEK <br />0 Standard ❑ ALT/I" Friday off: El207(k) <br />2 Standard ❑ ALT/1`t <br />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 BE SIGNED IN BLUE INK) <br />P R <br />MENT EAD / ELECTED FFICIAt �I DATE <br />BUDGET/P ROLL <br />DATE <br />�14f AN R U E <br />U <br />DATE <br />tW/ <br />COMMISSIDIIA <br />T <br />h� <br />S 2 <br />DATE <br />COMMI [ <br />DAl <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRMUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date EvalRating(IE— ID — S — AA — S) Initial <br />