Dd Form 2906d - Defense Civilian Intelligence Personnel System (Dcips) Performance Evaluation Of Record, October 2011 Page 2

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DEFENSE CIVILIAN INTELLIGENCE PERSONNEL SYSTEM (DCIPS)
PERFORMANCE EVALUATION OF RECORD
(Please read Privacy Act Statement and Instructions before completing this form.)
PART A - ADMINISTRATIVE DATA
1. EMPLOYEE NAME (Last, First, Middle Initial)
2. SOCIAL SECURITY NUMBER (Last 4 digits)
XXX-XX-
3. POSITION TITLE
4. PAY SCHEDULE/OCCUPATIONAL SERIES/PAY BAND/GRADE
6. DUTY STATION
5. ORGANIZATION
7. PAY POOL ID
a. START DATE
b. END DATE
8. EVALUATION PERIOD
(YYYYMMDD)
(YYYYMMDD)
9. EVALUATION OF RECORD EFFECTIVE DATE
10. PERFORMANCE PLAN LAST MODIFIED
(YYYYMMDD)
(YYYYMMDD)
PART B – PERFORMANCE EVALUATION DOCUMENTATION
PERFORMANCE
CLOSEOUT
PERFORMANCE
MIDPOINT
EVALUATION OF RECORD
(other than early annual)
PLAN
REVIEW
Closeout-Early Annual
EMPLOYEE:
Signature:
(YYYYMMDD)
Date
RATING OFFICIAL
Printed Name:
Signature:
(YYYYMMDD)
Date:
Communication
(face-to
Method
face, telephone, other)
REVIEWING OFFICIAL:
Printed Name:
Signature:
(YYYYMMDD)
Date:
1
DD Form 2906D, OCT 2011

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