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C� <br />KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Read <br />_ <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Robin R1881 01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION REASON FOR SEPARATION <br />Q 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 />❑ MERIT / STEP <br />❑ POSITION CHANGE (Describe Below) <br />❑ BUDGET CHANGE (Describe Below) <br />❑ LEAVE (List Type Below) <br />❑ TERMINATION (Provide Separation Info) <br />OTHER (Describe Below) <br />❑ DISCHARGE (D) ❑ PERFORMANCE (P) <br />❑ RESIGNATION (Q) ❑ ATTENDANCE (A) <br />❑ RETIRED (R) ❑ CONDUCT (C) <br />❑ LAID OFF (L) ❑ OTHER EMPLOYMENT (E) <br />❑ FAIL PROBATION (P) ❑ PERSONAL (L) <br />❑ OTHER (0) ❑ OTHER (0) <br />❑ Eligible For Rehire <br />g' [:1 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 />Enterexisting dotalrom CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />PUBLIC HEALTH ADMINISTRATOR <br />OCCUPATION CODE <br />1306 <br />UNION CODE <br />30 <br />PAY GRADE <br />106 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt Q Exempt ❑ Not Covered <br />❑ Non -Exempt Q Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ❑' PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible Q PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />8/2/2006 <br />ADJ HIRE DATE <br />8/2/2006 <br />POSITION DATE <br />9/1/2013 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$6,004.00 <br />$IbAbl.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />p 100% [:180% ❑ 75% ❑ 60% [150% <br />0 100% ❑ 80% ❑ 75% ❑ 60% [:150% <br />FTE WAGE <br />$ 6,004.00 <br />$ 6,461.00 <br />PAYMENT METHOD <br />❑ HOURLY ❑' MONTHLY <br />❑ HOURLY [j] MONTHLY <br />DEPARTMENT <br />PUBLIC HEALTH <br />BUDGET NUMBER <br />A. 116 000000000061151001 %: 100.00 <br />B. %: <br />A. %: <br />B. %: <br />WORKWEEK <br />❑' Standard ❑ ALT/1" Friday off: F -1207(k) <br />❑� Standard ❑ ALT/I" 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) <br />$ 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 />DEPARTMENT HEAD/ ELECTED OFFICIAL <br />DATE <br />BUDGET/PAYRp DATE <br />- 2I/f(// <br />( <br />HUMAN RESOURCE <br />1 DATE <br />I ) <br />COMMISSIO DATE <br />112 j <br />!�! ) <br />DATE <br />�6 G_ <br />COMMl55! r �— D4�' _1 <br />2:4 <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date EvalRating(IE- ID - S - AA - S) Initial <br />