(Employee to complete)
Employee Name: ___________________________________________ Department: _____________________
Current Date: _____________________ Title: ____________________________________________________
Current Evaluator Name/Title: ________________________________________________________________
Check appropriate answers and comments to below.
Do you understand the requirements of your job?
Yes
Partly
No
Do you feel your training has been adequate to
Successfully complete your job?
Yes
Partly
No
Do you have regular opportunities to discuss
your work and objectives with your manager?
Yes
Partly
No
Would you like to have more informal meetings
with your manager than you are currently having? Yes
Partly
No
Do you have any skills, aptitudes, or knowledge not fully utilized in your job? ___________________________
If so, what are they and how could they be used? __________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Is there any special help or “coaching you would like from your manager? ______________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
How well does your position satisfy your personal/professional goals? _________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What training, career, or future job opportunities are of interest to you? ________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please summarize your thoughts/feelings about your employment with our company.______________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Additional remarks, notes, questions, or suggestions. _______________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________________________________
________________________
Employee’s Signature
Date