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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Pilkington <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Dusty P2700 01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />TYPE OF SEPARATION 1 <br />❑ DISCHARGE (D) <br />❑ RESIGNATION (Q) <br />❑ RETIRED (R) <br />❑ LAID OFF (L) <br />❑ FAIL PROBATION (P) <br />❑ OTHER (0) <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <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 />❑ 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 />❑ PERFORMANCE (P) <br />❑ ATTENDANCE (A) <br />❑ CONDUCT (C) <br />❑ OTHER EMPLOYMENT (E) <br />❑ PERSONAL (L) <br />❑ 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 />PLANNER <br />OCCUPATION CODE <br />2458 <br />UNION CODE <br />40 <br />PAY GRADE <br />258 <br />STEP /POSITION <br />5 <br />FLSA STATUS <br />Q Non -Exempt ❑Exempt ❑Not Covered <br />Q Non -Exempt ❑ Exempt ❑ Nat Covered <br />DRS STATUS <br />❑ Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑ PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />5/23/2016 <br />AD1 HIRE DATE <br />6/10/2016 <br />POSITION DATE <br />5/23/2016 <br />LAST RAISE DATE <br />BASE WAGE <br />$3,428.00 <br />$4, 40.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />0 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />Q 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$3,428.00 <br />$4,340.00 <br />PAYMENT METHOD <br />❑ HOURLY Q MONTHLY <br />❑ HOURLY [H] MONTHLY <br />DEPARTMENT <br />COMMUNITY DEVELOPMENT SERVICES <br />BUDGET NUMBER <br />A. 402 000002042120151001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />[KI Standard ❑ ALT/1" Friday off: __ ❑ 207(k) <br />0 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 $ 0.0Q <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 SI IN BLUE INK) <br />KIFTMENT H / ELECTED OFFICIAL )AT( <br />kV4 S/ � <br />BUDGET/ AYRC#LC D.�AT <br />HUMAN RESOURCE / <br />f <br />DA <br />, <br />COMMIS si ( DAT <br />1 <br />C I <br />DATE <br />2, I <br />COM N 0 TE <br />� --- �- <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update EvalDate _ EvalRating(IE— ID — S — AA — S) Initial <br />