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Oft 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 />Green <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Amber A1744 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 Enter new data <br />JOB TITLE <br />PLANS EXAMINER <br />OCCUPATION CODE <br />2443 <br />UNION CODE <br />40 <br />PAY GRADE <br />243 <br />STEP/ POSITION <br />5 <br />FLSA STATUS <br />[j] Non -Exempt ❑ Exempt ❑ Not Covered <br />Q Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible El PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible El PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />7/6/2005 <br />ADJ HIRE DATE <br />7/6/2005 <br />POSITION DATE <br />11/3/2014 <br />LAST RAISE DATE <br />1/1/2016 <br />1 <br />BASE WAGE <br />$3,795.00 <br />$4,1647.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />[j] 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />Q 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$3,795.00 <br />$4,647.00 <br />PAYMENT METHOD <br />❑ HOURLY Q MONTHLY <br />❑ HOURLY E] MONTHLY <br />DEPARTMENT <br />COMMUNITY DEVELOPMENT SERVICES <br />BUDGET NUMBER <br />A. 402 000001042020251001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />� Standard ❑ ALT/I" Friday off: ___ ❑ 207(k) <br />Q Standard ❑ ALT/0 Friday off: __ ❑ 207(k) <br />To continue any allowance, stipend, <br />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 />FNT H D j ELECTED OFFICIAL I DATFj <br />3r� <br />BUDGET/ IiYROL DATE <br />- <br />1t N RESOURCE <br />r DA E <br />COMM, DATE <br />//// -,4q <br />ORR EDATE <br />COMAts5rc E UA IX <br />ri <br />rI} <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 />