Staff Performance Appraisal Form Page 3
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PERFORMANCE APPPRAISAL FORM
RATER’S OVERALL COMMENTS:
SECOND LEVEL SUPERVISOR’S COMMENTS: (Optional)
EMPLOYEE’S COMMENTS (Use attachments, if necessary):
EMPLOYEE’S SIGNATURE: _____________________________________________ DATE: _____________________
Signature does not imply concurrence with rater’s appraisal, only that appraisal was administered.
PLEASE PRINT
RATER’S NAME: _______________________________________________________
RATER’S SIGNATURE: __________________________________________________ DATE: _____________________
PLEASE PRINT
SECOND-LEVEL SUPERVISOR’S NAME: ______________________________________________________________
SECOND-LEVEL SUPERVISOR’S SIGNATURE: ____________________________ DATE: _____________________
EMPLOYEE’S REFUSAL TO SIGN: I certify that this performance appraisal was discussed with the employee who
refused to sign it.
RATER’S CERTIFICATION: ______________________________________________ DATE: ____________________
*Please deliver form to the Division of Human Resources, Payroll Department, PC 220.
Distribution:
Original – Human Resources
Copy – Supervisor
Copy - Employee
Revised 10/15/2007
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Parent category: Business