Enrollee Evaluation Of Work Experience Form printable pdf download

Enrollee Evaluation Of Work Experience Form

SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM

ENROLLEE EVALUATION OF WORK EXPERIENCE

To be completed every APRIL & OCTOBER and at termination by Trainee and discussed with Supervisor and Older

Worker Specialist.

APRIL

OCTOBER

AT TERMINATION

HOST AGENCY

PHONE

:___________________________________

:______________________________

SUPERVISOR

TRAINEE

POSITION_______ -____

:_____________________________

:_________________________________

TRAINING BEGIN DATE:___________ END DATE:_________

TOTAL TIME:______________

Employment goal(s): _______________________________________________________

Target Date for Employment:

_________________________________________________

Tasks that trainee is learning and practicing to prepare for employment.

Can Perform

Needs

independently

with Support

Instruction

or Notes for Reference

and Guidance Not Done

A. ___________________________

B. ___________________________

C. ___________________________

D. ___________________________

E. ___________________________

F. ___________________________

In reviewing the position description, are current duties in keeping with those listed above?

Yes

Explain differences:

_____________________________________________________________________

______________________________________________________________________________________________________

Suggestions for additional training, special projects, or upgrading of position description:

___________________________________________________________________________________________________________

Comments or suggestions for tasks where additional instruction and guidance are needed:

Trainee Name:

Position:_______-____

Page 2

____________________________

F:\Website\employ\Selfeval.doc

Enrollee Evaluation Of Work Experience Form

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