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r�KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE—ID—S—AA—S) Initial <br />SECTION 1: EMPLOYEE DATA <br />LAST NAME <br />Van De Venter <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Clinton V2511 1/01/2017 <br />SECTION 2: TYPE OF ACTION <br />EMPLOYEE TYPE <br />EMPLOYEE ACTION <br />TYPE OF SEPARATION REASON FOR SEPARATION <br />ULL-TI ME (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 />ERM''INATION (Provide Separation Info) <br />THER (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 />1 <br />Provide Details of Separation Below <br />COMMENTS: Increase per wage survey -payment effective 1/1/17; deferred until February payroll. <br />i 1 0 A lel l ' j <br />SECTION 3: POSITION DATA <br />Enter existing data from CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />HHW SUPERVISOR <br />OCCUPATION CODE <br />2321 <br />UNION CODE <br />30 <br />PAY GRADE <br />221 <br />STEP / POSITION <br />5 <br />FLSA STATUS <br />❑ Non -Exempt Q Exempt [:]Not Covered <br />Non -Exempt [j] Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible [j] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible I] PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />3/25/2014 <br />ADJ HIRE DATE <br />3/25/2014 <br />POSITION DATE <br />10/12/2015 <br />LAST RAISE DATE <br />1/1/2016 <br />l <br />BASE WAGE <br />$4,693.00 <br />$4,928.00 <br />LONGEVITY <br />$ 0.00 <br />$ <br />FTE <br />❑p 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />❑Q 100% [:180% ❑ 75% ❑ 60%E150% <br />FTE WAGE <br />$ 4,693.00 <br />$ 4,928.00 <br />PAYMENT METHOD <br />❑ HOURLY Q MONTHLY <br />❑ HOURLY ❑� MONTHLY <br />DEPARTMENT <br />SOLID WASTE <br />BUDGET NUMBER <br />A. 401 000000000040951001 %: 60.00 <br />B. 401000000004150151001 %:40.00 <br />A. %: <br />B. %: <br />WORKWEEK <br />Il Standard ❑ ALT/1" Friday off: ❑ 207(k) <br />E 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) $ 25.00 $ 25.00 <br />STIPEND (Detail in Comments Section) <br />$ 0,00 $ 0.00 <br />OTH ER (Detail in Comments Section) <br />$ 0.00 $ 0.00 <br />SECTION 4: SIGNATURES (MUST BE SIGNS I.N BLUE INK) <br />DEPARTM EAD'/ ELECT OFFI IAL_ PATE <br />Lail: <br />BUDGET/P OLL h O TE <br />-1311 <br />_.4� <br />HUMA RESOURCECOMMTS5[DW <br />C I <br />E <br />2►13E1 <br />COMMI ATE <br />� �` �-�3 <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update Eval Date Eval Rating (IE—ID—S—AA—S) Initial <br />