Employee Information - DOC

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					                        2012 STAFF PERFORMANCE ASSESSMENT FORM

                                             Employee Information

Employee Name                                                         Time in Job
Job Title                                                             Date:           /   /
Department
Manager/Supervisor
Assessment Period            /      /        to        /      /


                                             Performance Narrative

Provide a qualitative assessment of your employee’s performance. Also assess the employee’s progress in
meeting last year’s goals. Please limit your narrative to one page.




                                                       Goals

List your employee’s goals for the upcoming year. Include a due date for each goal.

Goal #1:




Goal #2:




Goal #3:




Goal #4:




    Revised 02/17/12
                                      Merit Adjustment Recommendation

Managers may recommend a modest merit pay increase for the employee based on his or her documented
performance. Will this employee receive a merit increase?

     Yes                No       Please explain:




                                              Employee’s Comments




   A signature is required only to indicate that you, the employee, have discussed this evaluation with your
   supervisor. Signing this document does not denote agreement.


   Employee’s Signature_____________________________________________ Date ________________

                                              Supervisor’s Signature


   Completed by___________________________________________________ Date _________________

   Department Head________________________________________________ Date _________________




   Revised 02/17/12

				
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