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j <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update___ EvalDate ___ Eval Rating (IE—ID—S—AA—S) Initial <br />I <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Mifflin <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Steph M1615 01/01/2017 <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) Provide Details of Separation Below <br />COMMENTS: Increase per wage survey - payment effective 1/1/17; deferred until February payroll. <br />JOB TITLE <br />OCCUPATION CODE <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report Enter new data <br />SENIOR PERMIT TECHNICIAN <br />2399 <br />UNION CODE <br />30 <br />PAY GRADE <br />299 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt E Exempt ❑ Not Covered <br />❑ Non -Exempt ❑� Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />6/15/2009 <br />ADJ HIRE DATE <br />3/14/2011 <br />POSITION DATE <br />2/17/2014 <br />LAST RAISE DATE <br />1/l/2016 <br />BASE WAGE <br />$3,887.00 <br />$4,571.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />Q 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50%❑ <br />100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$3,887.00 <br />$4,571.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />[]HOURLY ❑� MONTHLY <br />DEPARTMENT <br />COMMUNITY DEVELOPMENT SERVICES <br />BUDGET NUMBER <br />A. 402 000000104201051001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />0 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 <br />$ 0.00 <br />STIPEND (Detail in Comments Section) <br />$ 0.00 <br />$ 0.00 <br />OTHER (Detail in Comments Section) <br />$ 0.00 <br />$ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />TMENT D 1 ELECTED OFFICIAL <br />DA <br />OL1 BUDGET/ ATE <br />S �/3 /r <br />IiMAN RESOURCE <br />Lr <br />TE <br />[2 C7 <br />COMMIS # + DAT <br />NER <br />DATE <br />2` <br />COMMISSION D E <br />- r <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update___ EvalDate ___ Eval Rating (IE—ID—S—AA—S) Initial <br />I <br />