Base System Civilian Evaluation Report
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2BASE SYSTEM CIVILIAN EVALUATION REPORT
For use of this form, see AR 690-400; the proponent agency is ASA(M&RA)
PART I - ADMINISTRATIVE DATA
a. NAME (Last, First, Middle Initial)
b. POSITION TITLE, PAY PLAN, SERIES AND GRADE
c. ORGANIZATION/INSTALLATION
d. REASON FOR SUBMISSION
ANNUAL
SPECIAL
e. PERIOD COVERED (YYYYMMDD)
f. RATED MOS.
g. RATEE COPY (Check one and date)
FROM
THRU
GIVEN TO RATEE
FORWARDED TO RATEE
PART II - AUTHENTICATION
DATE (YYYYMMDD)
a. NAME OF RATER
SIGNATURE
(Last, First, Middle Initial)
GRADE/RANK, ORGANIZATION, DUTY ASSIGNMENT
DATE (YYYYMMDD)
b. NAME OF INTERMEDIATE RATER
SIGNATURE
(Optional)(Last, First, MI)
GRADE/RANK, ORGANIZATION, DUTY ASSIGNMENT
DATE (YYYYMMDD)
c. NAME OF SENIOR RATER
SIGNATURE
(Last, First, Middle Initial) (If used)
GRADE/RANK, ORGANIZATION, DUTY ASSIGNMENT
DATE (YYYYMMDD)
SIGNATURE OF RATEE
d. RATEE: I understand my signature does not constitute
agreement or disagreement with the evaluations of the Rater
and Senior Rater, and merely verifies Part I and Part IV data.
PART III - PERFORMANCE AWARD/QUALITY STEP INCREASE
% (OR) AWARD APPROVED BY
PERCENT OF SALARY( INCLUDES Locality Pay)
AMOUNT
$
(OR)
QSI (GS with Successful Level 1 Rating Only - minimum of 52 weeks
DATE (YYYYMMDD)
FUND CITE
must have elapsed since last QSI)
TO (Grade/Step)
PART IV - DUTY DESCRIPTION (Rater)
a. DAILY DUTIES AND SCOPE
. Position Description is correct:
YES
NO
(To include as appropriate: people, equipment, facilities, and dollars)
b. AREAS OF SPECIAL EMPHASIS
INITIAL
LATER (Optional)
MIDPOINT
LATER (Optional)
c.
COUNSELING DATES FROM
CHECKLIST/RECORD
PART V - VALUES (Rater)
VALUES
BULLET COMMENTS
Loyalty
Duty
Respect
Selfless service
Honor
Integrity
Personal courage
DA FORM 7223, MAR 2010
APD LC v1.02ES
PREVIOUS EDITIONS ARE OBSOLETE.
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