Form 0750 Sample - Performance Appraisal Program Page 5
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6NARRATIVE SUMMARY - OPTIONAL (Provide any additional significant accomplishments, as well as other factors such as details or training experiences related to the overall
performance plan. Capacity to assume a more responsible position may also be addressed.)
SAMPLE
SECTION D - OVERALL RATING
TYPE OF RATING
SUMMARY RATING
ANNUAL RATING OF RECORD
SPECIAL RATING OF RECORD
(POSITION CHANGES - EMPLOYEE OR RATER)
PERIOD COVERED BY THIS APPRAISAL
FROM
(MM/DD/YYYY)
TO
(MM/DD/YYYY)
NOTE: Recommended Performance Rating - Using achievement levels assigned in Section C and the criteria described below, check the
appropriate rating.
PERFORMANCE RATING
OUTSTANDING - Achievement levels for all elements are designated as Exceptional.
EXCELLENT - Achievement levels for all critical elements are designated as Exceptional. Achievement levels for noncritical elements are designated as
at least Fully Successful. Some, but not all, noncritical elements may be designated as Exceptional.
FULLY SUCCESSFUL - The achievement level for at least one critical element is designated as Fully Successful. Achievement levels for other critical
and noncritical elements are designated as at least Fully Successful or higher.
MINIMALLY SATISFACTORY - Achievement levels for all critical elements are designated as at least Fully Successful. However, the achievement
level(s) for one (or more) noncritical elements is (are) designated as Less Than Fully Successful.
UNSATISFACTORY - The achievement level(s) for one (or more) critical element(s) is (are) designated as Less Than Fully Successful.
SIGNATURE AND TITLE OF RATER
DATE
(MM/DD/YYYY)
SECTION E - HIGHER LEVEL REVIEW/APPROVAL
Required only for Minimally Satisfactory and Unsatisfactory ratings of record; unless organization has chosen to have higher level approval
required for Outstanding ratings of record.
Concur with recommended rating.
Do not concur with rating.
Approve rating of
.
BASIS FOR PERFORMANCE RATING CHANGE
SIGNATURE AND TITLE OF APPROVAL OFFICIAL
DATE
(MM/DD/YYYY)
SIGNATURE OF EMPLOYEE
DATE
(MM/DD/YYYY)
A copy of this performance appraisal was given to me.
VA FORM 0750, NOV 2003
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