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cl <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Haberman <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Jeremy H2573 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) <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 />❑ DISCHARGE (D) <br />❑ RESIGNATION (Q) <br />❑ RETIRED (R) <br />❑ LAID OFF (L) <br />❑ FAIL PROBATION (P) <br />❑ OTHER (0) <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 />BUILDING INSPECTOR <br />OCCUPATION CODE <br />2442 <br />UNION CODE <br />40 <br />PAY GRADE <br />242 <br />STEP / POSITION <br />7 <br />FLSA STATUS <br />0 Non -Exempt ❑ Exempt ❑ Not Covered <br />Non -Exempt [:]Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible [j] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible El PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />1/2/2015 <br />ADJ HIRE DATE <br />1/2/2015 <br />POSITION DATE <br />1/2/2015 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$3,390.00 <br />$3,821.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />[D 100% ❑ 80% ❑ 75% ❑ 60% [:150% <br />❑' 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 3,390.00 <br />$ 3,821.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY[j] MONTHLY <br />DEPARTMENT <br />COMMUNITY DEVELOPMENT SERVICES <br />BUDGET NUMBER <br />A. 402 000001042020251001 %: 100.00 <br />B. %: <br />A. N.: <br />B. %: <br />WORKWEEK <br />El Standard ❑ ALT/1" Friday off: __ ❑ 207(k) <br />[D 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 $ 0.00 <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 />7 97MENT /MELEDOFFICIAL D TE <br />BUDGETJPA7ROI RATE TE <br />HU AN RESOURCE <br />TE <br />COMMM DTE <br />COMM,IDATt <br />r <br />DATE <br />RETURN FORM TO HUMAN RESOURCES <br />FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update___ Eval Date _ EvalRating(IE— ID — S — AA — S) Initial <br />