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[ KITTITAS COUNTY PERSONNEL ACTION FORM (PAF) <br />LAST NAME <br />Highland <br />SECTION 1: EMPLOYEE DATA <br />FIRST NAME EMPLOYEE # EFFECTIVE DATE <br />Carole H2749 1-114.7 ill -711-7 <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 (C1) ❑ 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 0Ineligible For Rehire <br />Provide Details of Separation Below <br />COMMENTS: Increase per wage survey- effective I-�7; deferred until February payroll <br />%101x7 <br />SECTION 3: POSITION DATA <br />Enter existing datafrom CAMAS Wage Data Report <br />Enter new data <br />JOB TITLE <br />DPA III <br />OCCUPATION CODE <br />2317 <br />UNION CODE <br />30 <br />PAY GRADE <br />217 <br />STEP / POSITION <br />5 <br />❑ Non -Exempt ® Exempt ❑ Not Covered <br />FLSA STATUS <br />© Non -Exempt f5� Exempt ❑ Not Covered <br />DRS STATUS <br />❑ Ineligible ® PERS ❑ LEOFF ❑ PSERS ❑ Other <br />❑ Ineligible [N PERS ❑ LEOFF ❑ PSERS ❑ Other <br />HIRE DATE <br />1-17-17 <br />ADJ HIRE DATE <br />1-17-17 <br />POSITION DATE <br />1-17-17 <br />LAST RAISE DATE <br />1-17-17 <br />BASE WAGE <br />$6585 <br />$6756 <br />LONGEVITY <br />$0 <br />$ <br />FTE <br />0100%E] 80% ❑ 75% ❑ 60% ❑ 50% <br />© 100% ❑ 80% ❑ 75% ❑ 60% ❑ 50% <br />FTE WAGE <br />$6585 <br />$6756 <br />PAYMENT METHOD <br />❑ HOURLY ® MONTHLY <br />❑ HOURLY ® MONTHLY <br />DEPARTMENT <br />Prosecutor <br />BUDGET NUMBER <br />A.001290151001 /:100 <br />B. %; <br />A. r: <br />B. %: <br />WORKWEEK <br />® Standard ❑ ALT/1" Friday off: ❑ 207(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) <br />$25 <br />$ ` <br />STIPEND (Detail in Comments Section) <br />$0 <br />$ <br />OTHER (Detail in Comments Section) <br />$0 <br />$ <br />SECTI 4: SIGNATURES (MUST BE SIGNED IN BLUE INK) <br />DEPARTME q / £L£ E FACIAL DATE <br />BUD R ROLL DATE <br />DATE <br />COMMi TO DA E <br />CO H2 t <br />ATE <br />-1�t I' <br />COMMlSS E <br />9-113 <br />RETURN FORM TO HUMAN RESOURCES FOR DISTRIBUTION <br />Updated: 04/08/11 FOR HR USE: NT Update EvalDate EvalRating(IE— ID—S—AA—S) Initial <br />