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C-1 <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <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 />Moore <br />FIRST NAME <br />Erin <br />EMPLOYEE # <br />A2074 <br />EFFECTIVE DATE <br />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) ❑ NEW HIRE ❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />❑� PART-TIME (2) ❑ RE -HIRE ❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ LIMITED PART-TIME (3) ❑ MERIT/ STEP ❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ TEMPORARY (4) ❑ POSITION CHANGE (Describe Below) ❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ CASUAL (5) ❑ BUDGET CHANGE (Describe Below) ❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ SEASONAL (6) ❑ LEAVE (List Type Below) ❑ OTHER (0) ❑ OTHER (0) <br />❑ PROJECT (7) ❑ TERMINATION (Provide Separation Info) <br />❑ WORK STUDY (8) OTHER (Describe Below) ❑ Eligible For Rehire ❑ Ineligible For Rehire <br />❑ VOLUNTEER (9) _ 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 />ENVIRONMENTAL HEALTH SPEC 2 <br />OCCUPATION CODE <br />2472 <br />UNION CODE <br />40 <br />PAY GRADE <br />272 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />Non -Exempt ❑ Exempt ❑ Not Covered 19 Non -Exempt ❑ Exempt [:]Not Covered <br />DRS STATUS <br />❑ Ineligible ❑' PERS ❑ LEOFF ❑ PSERS ❑ Other ❑ Ineligible Q PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />5/19/2008 <br />ADJ HIRE DATE <br />15/19/2008 <br />POSITION DATE <br />1/1/2016 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$ 2,150.40 $ 2,332.20 <br />LONGEVITY <br />$ 0.00 $ <br />FTE <br />[:1100% ❑ 80% ❑ 75% ❑� 60% ❑ 50% ❑ 100% ❑ 80% ❑ 75% ❑D 60% [150% <br />FTE WAGE <br />$ 3,584.00 $ 3,887.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY ❑ HOURLY ❑� MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. 116 000000000061551001 %: 100.00 A. %: <br />B. %: B. %: <br />WORKWEEK <br />j <br />E] Standard ❑ ALT/1n Friday off: ❑ 207(k) ❑� Standard ❑ ALT/1Friday 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 />SECrION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />DEP ENTHi / f Ef}OFF! IAL DATE <br />BUDGET/ Y A1T4 <br />_2 <br />l- ] <br />HU N R OURCE <br />DATE <br />COMMISSS 1 DAT <br />CO ER <br />DATE <br />2.�1 �1 • <br />COML}15 D <br />� � � 3- � <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 />