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Mal <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update EvalDate Eval Rating (IE—ID—S—AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Blackwood <br />Jessie B1757 1-1-17 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION TYPE OF SEPARATION REASON FOR SEPARATION <br />® FULL-TIME (1) <br />❑ NEW HIRE ❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />❑ PART-TIME (2) <br />❑ RE -HIRE ❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ LIMITED PART-TIME (3) <br />❑ MERIT/ STEP ❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ TEMPORARY (4) <br />❑ POSITION CHANGE (Describe Below) ❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ CASUAL (5) <br />❑ BUDGET CHANGE (Describe Below) ❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ SEASONAL (6) <br />❑ LEAVE (List Type Below) ❑ OTHER (0) ❑ OTHER (0) <br />❑ PROJECT (7) <br />❑ TERMINATION (Provide Separation Info) <br />❑ WORK STUDY (8) <br />® OTHER (Describe Below) Eligible For Rehire ❑ Ineligible For Rehire <br />❑ VOLUNTEER (9) <br />Provide Details of Separation Below <br />COMMENTS: Increase per wage survey- payment effective 1-1-17; deferred to February payroll. <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report Enter new data <br />JOB TITLE <br />LS I <br />OCCUPATION CODE <br />_342_9 <br />UNION CODE <br />40 <br />PAY GRADE <br />329 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />® Non -Exempt ❑ Exempt ❑ Not Covered <br />Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ® PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />6-21-05 <br />ADJ HIRE DATE <br />3-29-10 <br />POSITION DATE <br />1-1-13 <br />LAST RAISE DATE <br />1-1-16 <br />1-1-17 <br />BASE WAGE <br />$2850. <br />$2993. <br />LONGEVITY <br />$0 <br />$0 <br />FTE <br />® 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$2850 <br />$2993 <br />PAYMENT METHOD <br />❑ HOURLY ® MONTHLY <br />❑ HOURLY RMONTHLY <br />DEPARTMENT <br />Prosecutor <br />BUDGET NUMBER <br />A.001290151001 %:100 <br />A. %: <br />B. %: <br />B. %: <br />WORKWEEK <br />❑ Standard ® ALT/1" Friday off: ❑ 207(k) <br />❑ Standard ❑ ALT/V 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 />$0 <br />$ <br />STIPEND (Detail in Comments Section) <br />$0 <br />$ <br />OTHER (Detail in Co ents Section) <br />$0 <br />$ <br />SECTION 4: SIGNATURES (MUST <br />BE SIGNED IN BLUE INK) <br />DEPARTM. H D/ ELECTED OFFI IA <br />DA7f. <br />BUDGET/PAYROL f D 7E <br />�. <br />;I 3 1l <br />HUMA ES0 <br />DATE <br />COMMI11lO D E <br />2, I7 <br />CO <br />DATE <br />COMMISS <br />2ATE <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 />