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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Cook <br />FIRST NAME <br />Mark <br />EMPLOYEE # <br />C2618 <br />EFFECTIVE DATE <br />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 />� <br />❑ POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />[TERMINATION (Provide Separation Info) <br />W7HER (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 />PUBLIC WORKS DIRECTOR <br />OCCUPATION CODE <br />1318 <br />UNION CODE <br />30 <br />PAY GRADE <br />118 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt 0 Exempt ❑ Not covered <br />❑ Non -Exempt ❑� Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible (] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible [j] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />5/4/2015 <br />ADJ HIRE DATE <br />5/4/2015 <br />POSITION DATE <br />5/4/2015 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$8,935.00 <br />$9,829.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />❑' 100% [:180% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$ 8,935.00 <br />$ 9,829.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑' MONTHLY <br />❑ HOURLY ❑� MONTHLY <br />DEPARTMENT <br />PUBLIC WORKS <br />BUDGET NUMBER <br />WORKWEEK <br />A. 000 RA3376 is 100.00 <br />B. OW <br />A. is <br />B. %: <br />0 Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />E 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) $ 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 />P RTMENT HEAD/ EVCTEDCIFFICI DATE <br />BUDGET/PAY OAT <br />/��r <br />uRce <br />TM <br />rE <br />2 T <br />COMM DA <br />❑ ! ER <br />DATE <br />CO I ` ^ _ � �E -, <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 />