Performance Evaluation Form (Page 4 of 4) in pdf

Performance Evaluation Form Page 4

PART III: PERFORMANCE PLAN

List the development objectives the employee has achieved during the evaluation period. Next, list your

developmental objectives, the activities through which you propose the employee should achieve them and the

projected timelines:

Comments:

PART IV: EVALUATOR’S SIGNATURE

Evaluator’s Name

Evaluator’s Signature

Evaluator’s Title

Date:

PART V: EMPLOYEE'S ACKNOWLEDGEMENT OF EVALUATION

__ I have had an opportunity to read and discuss this performance review with the evaluator.

__ I am attaching my comments regarding this evaluation.

__ I would like to discuss this evaluation with an Appropriate Administrator.

__ I decline to sign.

__ I will submit my rebuttal.

Employee's Signature _____________________________________________ Date ______________

PART VI: APPROPRIATE ADMINISTRATOR'S REVIEW

For Probationary employee only, recommend:



Grant Permanent Status



Reject During Probation (Forward Recommendation)

Comments (Include date and participants):

Administrator's Name: _________________________ Signature __________________________________

Title: ____________________________________ Date: ________________

Human Resources Department

Performance Evaluation Program

Performance Evaluation Form Page 4