APPENDIX C

Performance Evaluation Report

Regular/Probationary Classified Employees

Employee's Name Social Security Number (Last 4)

Classification Anniversary Date of Hire:

Type of Evaluation: Six Month (Probationary) Eleventh Month (Probationary) Annual Unscheduled

HR - Classified Evaluation Form Keep a copy for your records and forward a copy to Human Resources

A B C D E Section 2-- Job strengths and superior performance

Meets

Sta

ndar

ds

Requir

es

Impro

vem

ent

No

t Sat

isfa

cto

ry

Does

Not

Apply

Section 1

Factor Check List

(Immediate Supervisor

must check each factor

in the appropriate column)

Exce

eds

Section 3-- Job weaknesses and less than sufficient performances (Explain checks in column D if any)

1--Observation of work hours

2--Dependability

3--Compliance with rules

4--Safety practices

Section 4-- Progress achieved in attaining previously set goals for improved work performance, for personal, or job qualifications

5--Public interaction

6--Student interaction

7--Employee interaction

8--Knowledge , Skill and Ability

9--Work judgements

10--Planning and organizing

11--Initiative

Section 5-- Specific goals to be undertaken during next evaluation period 12--Quality of work

13--Quantity of Work

14--Team Work

15--Meeting deadlines

16--Responsibility

17--Follows direction

18--Adaptability

Summary Evaluation [Check () overall performance]

Exceeds Standards Meets Standards Requires Improvement Not Satisfactory Not Observed

19--Effectiveness under pressure

20--Professionalism

21--Neatness of work station

22--Use of Equipment

Supervisor's-- I certify that this report represents my best judgement. I do I do

not recommend this employee be granted permanent status. (For final probationary

reports only)

Additional Factors (Related to job description)

23--

24--

25-- Supervisor's Signature Date

26--

27-- Title 28--

29--

Reviewer (If none, so indicate) Employee: I certify that this report has been discussed with me.

I understand my signature does not necessarily indicate agreement. I

understand that it is recommended that I respond within ten (I0)

working days in writing to any material in this report and that my

response will be attached to this report. (Please place comments on

a separate sheet of paper and attach to this report.)

Reviewer's Signature Date

Title

HR Reviewer's Signature Date

Employee's Signature Date

Title