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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 FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Fuller Amy F2397 1/1/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE EMPLOYEE ACTION TYPE OF SEPARATION 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) 1 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 />ASSESSMENT COORDINATOR I <br />OCCUPATION CODE <br />2487 <br />UNION CODE <br />40 <br />PAY GRADE <br />287 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑' Non -Exempt ❑ Exempt ❑ Not Covered <br />Q Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />8/6/2012 <br />ADJ HIRE DATE <br />8/6/2012 <br />POSITION DATE <br />9/1/2013 <br />LAST RAISE DATE <br />1/1/2016 <br />t ,1 n <br />BASE WAGE <br />$3,730.00 <br />$4,320.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑� 100% ❑ 80% [:175% ❑ 60% ❑ 50% <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$3,730.00 <br />$4,320.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY Q MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. 116 000000006118151001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />❑' Standard ❑ ALT/1't Friday off: ❑ 207(k) <br />❑' Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, or other, it must be listed in both columns for audit purposes or the amount will default to "0". <br />ALLOWANCE (Detail in Comments Section) <br />$ 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 SIGNER BLUE INK) <br />DE T OFFICIAL <br />DATE <br />BUDGET/P YROLL DATE <br />H MAN RESOURCE <br />DATE <br />I <br />COMM E DATE <br />M T I R ii <br />TE COM l5ArE <br />= 1 t C;? -f f <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 />