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011 <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Keith <br />FIRST NAME <br />Sarah <br />EMPLOYEE # <br />K1526 <br />EFFECTIVE DATE <br />01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION REASON FOR SEPARATION <br />❑� FULL-TIME (1) ❑ NEW HIRE ❑ DISCHARGE (D) _E1 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 />103 \\ v 1 p p, a <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report Enter new data <br />JOB TITLE <br />SUPERIOR COURT ADMIN <br />SUPERIOR COURT ADMIN <br />OCCUPATION CODE <br />1319 <br />1319 <br />UNION CODE <br />30 <br />30 <br />PAY GRADE <br />119 <br />119 <br />STEP / POSITION <br />5 <br />5 <br />FLSA STATUS <br />❑ Non -Exempt 0 Exempt ❑ Not Covered ❑ Non -Exempt 0 Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible [j] PERS ❑ LEOFF [:1 PSERS <br />❑ Other ❑ Ineligible E] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />5/8/2003 <br />5/8/2003 <br />ADJ HIRE DATE <br />5/8/2003 <br />5/8/2003 <br />POSITION DATE <br />8/3/2015 <br />8/3/2015 <br />LAST RAISE DATE <br />1/1/2016 <br />1/1/17 <br />BASE WAGE <br />$4,303.00 <br />$5,675.00 <br />LONGEVITY <br />$ 0.00 <br />$ 0 <br />FTE <br />❑� l00% ❑ 80% ❑ 75% [:160% ❑50% 0 l00% ❑ 80% [175% ❑60% ❑ 50% <br />FTE WAGE <br />$4,303.00 <br />$5,675.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑� MONTHLY <br />❑ HOURLY Q MONTHLY <br />DEPARTMENT <br />SUPERIOR COURT <br />SUPERIOR COURT <br />BUDGET NUMBER <br />A. 001 000000000002151001 <br />B. <br />%: 100.00 A. 001 000000000002151001 %: 100 <br />%: B. %: <br />WORKWEEK <br />0 Standard ❑ ALT/1" Friday off: <br />❑ 207(k) 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) $ 25.00 <br />$ 25.00 <br />OTHER (Detail in Comments Section) <br />$ 855.25 <br />$ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />ART W A J EDOFFICIA <br />DATE <br />BUDGE <br />PAY 61 LI. DAT <br />HYMAN RESOURCE <br />DATE <br />C[)Idl <br />' E <br />COL MI' I N <br />DATE <br />COMMF <br />` AT <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 />