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C� <br />?�� K11 111AJ UVU1V IV lrhKN(JN1VhL AUTIUN rORM NAY <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />DAVIS I TODD I D1317 101/01/17 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />E FULL-TIME (1) <br />❑ NEW HIRE <br />❑ DISCHARGE (D) <br />❑ PERFORMANCE (P) <br />❑ PART-TIME (2) <br />❑ RE -HIRE <br />❑ RESIGNATION (Q) <br />❑ ATTENDANCE (A) <br />❑ LIMITED PART-TIME (3) <br />Sm . Ep <br />❑ RETIRED (R) <br />❑ CONDUCT (C) <br />❑ TEMPORARY (4) <br />❑ POSITION CHANGE (Describe Below) <br />❑ LAID OFF (L) <br />❑ OTHER EMPLOYMENT (E) <br />❑ CASUAL (5) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ FAIL PROBATION (P) <br />❑ PERSONAL (L) <br />❑ SEASONAL (6) <br />❑ LEAVE (List Type Below) <br />❑ OTHER (0) <br />❑ OTHER (0) <br />❑ PROJECT (7) <br />TEKM1NATION (Provide Separation Info) <br />PAYMENT METHOD <br />❑ HOURLY E MONTHLY ❑ DAILY <br />El WORK STUDY (8) <br />uEk (Describe Below) <br />❑ Eligible For Rehire ❑ Ineligible For Rehire <br />❑ VOLUNTEER (9) <br />{.'OMMi-N'rs (include work schedule if position is <br />Placement on revised wage scale. <br />$60 Smart Phone Allowance <br />F41-jaNI F"y J - <br />Provide Details of Senaration Below <br />SECTION 3: POSITION DATA <br />Enter exisling data from payroll system Enter new data to be input into eqvroii system <br />JOB TITLE WEED BOARD COORDINATOR <br />OCCUPATION CODE 1348 <br />UNION CODE 30 <br />PAY GRADE 148 <br />STEP / POSITION 5 5 <br />FLSA STATUS <br />❑ Non -Exempt E Exempt ❑ Not Covered <br />❑ Non -Exempt 10 Exempt ❑ Not Covered <br />DRS STATUS <br />EI -Ineligible E PERS ❑ LEOFF ❑ PSERS <br />❑ Ineligible [4 PERS ❑ LEOFF ❑ PSERS <br />HIRE DATE <br />05/08/00 <br />ADJ HIRE DATE <br />05/08/00 <br />POSITION DATE <br />01/01/01 <br />LAST RAISE DATE <br />01/01/16 <br />01/01/17 <br />BASE WAGE <br />$4972 <br />$5469 <br />LONGEVITY <br />$0 <br />$ <br />FTE <br />E 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />100% ❑ 80% E-175% ❑ 60% ❑ 50% <br />FTE WAGE (Calculate if FTE < 100%) <br />$4972 <br />$5469 <br />PAYMENT METHOD <br />❑ HOURLY E MONTHLY ❑ DAILY <br />❑ HOURLY MONTHLY ❑ DAILY <br />DEPARTMENT <br />NOXIOUS WEED <br />BUDGET NUMBER A.1230000000051001 A.100% A. A. % <br />B. B. % B. B. % <br />WORKWEEK E Standard ❑ Alternate ❑ 207(k) exception ❑ Standard ❑ Alternate ❑ 207(k) exception <br />ALLOWANCE (Detail in Comments Section) $60 $60 <br />STIPEND (Detail in Comments Section) $0 $ <br />OTHER (Detail in Comments Section) $0 $ <br />SECTION 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />DEPNt'I'MENT READ /ELECTED OFF C:IAL BATE. 11UDGU, 1PAYR DATE <br />559 <br />Fi` MAN RFS IJR DATE COMM[SS lF DATE <br />•R#2 DATE COMM. Fi f <br />�. X13 ► l�- �� �- /.3-i � <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 08/27/07 FOR HR USE: PAF Log NT Update Eval Date Eval Rating (IE — ID — S — AA — S) Initial <br />