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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />4 SECTION 1: EMPLOYEE DATA <br />LAST NAME FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Vavricka � Zach V2605 01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />F.rrmerexisbng data from CAMASWoQe Data Report <br />EMPLOYEE ACTION <br />JOB TITLE <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />❑ FULL-TIME (1) <br />2433 <br />❑ NEW HIRE <br />UNION CODE <br />[] DISCHARGE (D) <br />❑ PERFORMANCE (P) <br />Q PART-TIME (2) <br />233 <br />❑ RE -HIRE <br />STEP / POSITION <br />❑ RESIGNATION (Q) <br />❑ ATTENDANCE (A) <br />❑ LIMITED PART-TIME (3) <br />0 Non -Exempt []Exempt ❑ Not Covered <br />❑ MERIT/ STEP <br />DRS STATUS <br />❑ RETIRED (R) <br />❑ CONDUCT (C) <br />❑ TEMPORARY (4) <br />4/6/2015 <br />❑ POSITION CHANGE (Describe Below) <br />ADJ HIRE DATE <br />❑ LAID OFF (L) <br />❑ OTHER EMPLOYMENT (E) <br />❑ CASUAL (5) <br />4/6/2015 <br />❑ BUDGET CHANGE (Describe Below) <br />LAST RAISE DATE <br />❑ FAIL PROBATION (P) <br />❑ PERSONAL (L) <br />❑ SEASONAL (6) <br />BASE WAGE <br />❑ LEAVE (List Type Below) <br />$'1,M4.50 ' <br />❑ OTHER (0) <br />❑ OTHER (0) <br />❑ PROJECT (7) <br />FTE <br />❑ TERMINATION (Provide Separation Info) <br />❑ 100% ❑ 80% ❑ 75% ❑ 60% 50% <br />FTE WAGE <br />$ 3,483.00 <br />❑ WORK STUDY (8) <br />PAYMENT METHOD <br />Q OTHER (Describe Below) <br />❑ HOURLY MONTHLY <br />❑ Eligible For Rehire <br />❑ Ineligible For Rehire <br />❑ VOLUNTEER (9) <br />BUDGET NUMBER <br />A. 116 000000006121151001 %: 100.00 <br />B, %: <br />A. %: <br />B. %: <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 />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 />F.rrmerexisbng data from CAMASWoQe Data Report <br />Enter new data <br />JOB TITLE <br />HEALTH PROMOTION SPECIALIST I <br />$ 0.00 <br />OCCUPATION CODE <br />2433 <br />$ 0.00 <br />UNION CODE <br />40 <br />SECTION 4: SIGNATURES IMUST BE SIGNED IN BIJUIE <br />PAY GRADE <br />233 <br />STEP / POSITION <br />6 <br />BUDGET/PAYROLL <br />FLSA STATUS <br />0 Non -Exempt []Exempt ❑ Not Covered <br />Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑� PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible M PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />4/6/2015 <br />ADJ HIRE DATE <br />4/6/2015 <br />Updated: 04/08/11 FOR HR USE: <br />POSITION DATE <br />4/6/2015 <br />LAST RAISE DATE <br />1/1,12016 <br />_ <br />BASE WAGE <br />$1,741.50 <br />$'1,M4.50 ' <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑ 100% ❑ 80% ❑ 75% ❑ 60% 2 50% <br />❑ 100% ❑ 80% ❑ 75% ❑ 60% 50% <br />FTE WAGE <br />$ 3,483.00 <br />$ 3,729.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. 116 000000006121151001 %: 100.00 <br />B, %: <br />A. %: <br />B. %: <br />WORKWEEK <br />❑� Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />Standard ❑ ALT/1s` 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) <br />$ 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 IMUST BE SIGNED IN BIJUIE <br />INK) <br />D ENT IAL <br />D <br />BUDGET/PAYROLL <br />H MAN RESOURCE <br />DATE <br />COMMI55i <br />C E #2 <br />DATE <br />i <br />COMMI 3 <br />RETURN FORM TO HUMA9 RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: <br />NT Update Eval Date <br />EvalRating(IE—ID—S—AA—S) Initial <br />