State Form 19956 - Employee Performance Appraisal Report - Protective Occupations

Download a blank fillable State Form 19956 - Employee Performance Appraisal Report - Protective Occupations in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete State Form 19956 - Employee Performance Appraisal Report - Protective Occupations with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Employee name:____________________________________________
EMPLOYEE PERFORMANCE
TYPE OF EVALUATION
PROTECTIVE OCCUPATIONS
APPRAISAL REPORT
Annual
3-Month
6-Month
Follow-up
State Form 19956 (R5 /2-99)
Other:
*Social Security number request is mandatory
per IC 4-1-8-1 (5)
WORKING TEST
This information may be used in decisions
Successfully completed: Permanent status granted. EFFECTIVE DATE:
concerning training needs, advancement,
performance-related salary adjustments,
Request extension for six (6) months. Reason on Comments Sheet. EXTENDED DUE DATE:
layoffs, reemployment, and as evidence in
contested disciplinary actions.
State Personnel Director approval
Date (month, day, year)
*Social Security number
Name of employee
Name of state agency
Org code
Class title and class code of employee
Review period (month / year)
To
AREAS OF RESPONSIBILITY
QUALITY
IMP.
QUANTITY
TIMELINESS
INSTRUCTIONS
RESPONSIBILITY STATEMENT
Na
Es Ne
=
Na
=
=
Na
=
=
1.
1) List the applicable areas of responsibility
from the position description. 2) Indicate the
2.
relative importance of each in the second column.
3.
3) Assign a rating to each dimension based on
4.
the actual work performed. Substantiate ratings of
"below standard" on Comments Sheet.
5.
:
key
Essential
Non-Essential
Es
Ne
6.
Not applicable
Below standard
Na
7.
At standard
Above standard
=
8.
GENERAL FACTORS
IMPORT.
PERFORMANCE
INSTRUCTIONS
FACTOR
Es
Ne
U
Na
M
S
V
0
1. Job Knowledge and Skill
1) Indicate the relative importance of each
factor in the first column. 2) For each applicable
2. Follows Proper Procedures / Judgement
factor, assign the most suitable performance
3. Dependability
rating. Substantiate ratings of "Unsatisfactory"
or "Outstanding" on Comments Sheet.
4. Composure / Stability
Key:
Essential
Non-Essential
Ne
Es
5. Motivation
Not applicable
Unsatisfactory
U
Na
6. Adaptability
Marginal
Satisfactory
S
M
7. Interpersonal Relations
Very good
Outstanding
O
V
Evaluator signature
Superior
Appointing Authority signature
Employee signature
Date signed
Date
I hereby certify that I have had an opportunity to review this report and
I hereby certify that this rating report constitutes my best judgment of the service performed by this employee for the review period
understand that I am to receive a copy. I am aware that my signature
covered.
does not necessarily mean that I agree with the rating.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go