May Be Used For Any Classification

Employee Name Payroll Title (Class) upervisor!s Name Department Date Hired

Prepare in duplicate
Original-Employing Dept. File Copy to the Employee Length of time in present job upervisor!s Payroll Title Years Division Mos Period o!ered by this e!al"ation F#OM $O Length of time yo" Years Mos ha!e s"per!ised this employee

PE"F#"MANCE E$A%UAT&#N
&PE# '() *#+,))) #etn- Offi e of #e ord- . Years /fter %eparation Other Copies- 0 - . Years /fter E!al"ation

CHEC' #NE

%"perior More than %atisfa tory %atisfa tory 1mpro!ement 2eeded &nsatisfa tory

3(o) "esponsi)ilities for Period of Evaluation

Comments and #)*ectives

3Ea h s"per!isor and member of the &ni!ersity Management Program 4ho has dire t responsibility for meeting established ommitments to e5"al employment opport"nity and affirmati!e a tion goals shall be e!al"ated on his,her good faith efforts in these areas.

Performance Evaluation Form UPE" +,#ffice of t.e Human "esources

'

#verall Evaluation

Unsatisfactory

&mprovement Needed

atisfactory

More t.an atisfactory

uperior

Comments

Future Plans and Actions

i/nature of &mmediate upervisor

Date

Yo"r signat"re indi ates neither agreement nor disagreement 4ith the e!al"ation6 b"t it does indi ate that yo" ha!e read the e!al"ation6 and it has been dis "ssed 4ith yo". 1f yo" 4ish6 yo" may omment in the spa e belo4.

Department Head i/nature

Date

Employee!s i/nature

Date

Employee Comments

Performance Evaluation Form UPE" +,#ffice of t.e Human "esources