Please type or print your responses.  If necessary, attach additional pages.

Use the following scale to reply to each question:

1 = Consistently Fulfills and Exceeds Duties

2 = Fulfills and Frequently Exceeds Duties

3 = Fulfills Duties

4 = Sometimes Fulfills Duties

5 = Rarely Fulfills Duties

I. Performance Goals from Last Appraisal Period

List the goals in the space provided and rate the improvement using the scale above. 

_____1)

_____ 2)

_____ 3)

_____ 4)

_____ 5)

_____ 6)

II. Job Description

In the space below write out the job description. Please note any changes in the job description since the last evaluation.

III. General Evaluation

Using the codes below, please fill in the following chart.

CATEGORY

1

2

3

4

RECOMMENDATIONS/EVALUATIONS

INTERPERSONAL SKILLS: Please consider:
(1) ability to get along with: supervisors, subordinates, co-workers and outside contacts;

(2) also consider level of emotional maturity and professionalism displayed.

GENERAL WORK PERFORMANCE: Please consider:
(1) the amount of work produced;

(2) if projects are completed on time due; and

(3) ability to follow and complete work as instructed.

WORK ETHICS: Please consider:
(1) promptness and attendance record; and

(2) enthusiasm toward projects/assignments

JOB REQUIREMENTS: Please consider employee's technical skills

Codes: 1 = Outstanding; 2 = Good; 3 = Fair; 4 = Poor

IV. Give an overall numerical value to this employee's performance.