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KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Haberman <br />_ SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Laurie H009E 01/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION <br />REASON FOR SEPARATION <br />❑✓ 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 ❑ Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: Increase per wage survey- <br />payment effective 1/1/2017; deferred <br />until February payroll. <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />DIVERSION COORDINATOR <br />OCCUPATION CODE <br />2405 <br />UNION CODE <br />40 <br />PAY GRADE <br />205 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />(] Non -Exempt ❑ Exempt ❑ Not Covered <br />0 Non -Exempt ❑ Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible Il PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible Il PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />6/24/1998 <br />ADJ HIRE DATE <br />12/7/1998 <br />POSITION DATE <br />7/5/2000 <br />LAST RAISE DATE <br />1/1/2016 <br />BASE WAGE <br />$ 3,902.00 <br />$ 4, 92.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑� 100% C]80% [:]75% [:]60% ❑ 50% <br />❑� 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$3,902.00 <br />$4,292.00 <br />PAYMENT METHOD <br />❑ HOURLY I] MONTHLY <br />❑ HOURLY 0 MONTHLY <br />DEPARTMENT <br />JUVENILE PROBATION <br />BUDGET NUMBER <br />A. 001 000000000220251001 %: 56.25 <br />B. 001000000220222151001 %:43.75 <br />A. %: <br />B. %: <br />WORKWEEK <br />E Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />Il Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />To continue any allowance, stipend, or other, it must be listed in both columns for audit purposes or the amount will default to "0". <br />ALLOWANCE (Detail in Comments Section) <br />$ 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 />SE ION 4: SIGNATURES MUST BE SIGNED IN BLUE INK <br />DEPA TMEN 8i EDO icl <br />HU R OLIRCEDATE <br />DAT <br />111 <br />BUDGET AYRO DAT,, <br />7I/ 3 / <br />COMM10 DA <br />2d] <br />cc <br />DATE <br />COMMI TE <br />(7 / <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eva[Date EvalRating(IE— ID — S —AA—S) Initial <br />