Page 1 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA AB AC AD

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					                                                                                                  The Navajo Nation
                                                                                       EMPLOYEE PERFORMANCE APPRAISAL FORM
                                                                                                for Exempt Employees
                                                                                                                                     NEW EMPLOYEE               ANNUAL                   OTHER
NAME:                                                                            SSN:                                                INTRODUCTORY               APPRAISAL                (Specify)

DEPT #       133              DEPT. NAME                        Local Governance Support Center                                      APPRAISAL PERIOD                                                  TO
OBJECTIVES                                 (As defined by the supervisor and acknowledged by the employee)                        WEIGHT                                                       RATING
 1. Ensure the full implementation of the Chapter's Five Management System (Fiscal, Personnel, Procurement, Property and Record Check one                                                 Circle one
                                                                                                                                    Critical                                              5 Outstanding
    Management) in accordance to the policy and procedures, and the chapter goals and objectives by the end of FY2008.                                                                    4 Significantly exceeds standards
    Including the In-House Policies and to exercises supervisory control and guidance on daily basis of overall chapter employees   Major                                                 3 Meets standards
    engaged in their prescribed duties and responsibilities.                                                                                                                              2 Does not fully meet standards
                                                                                                                                    Secondary                                             1 Unsatisfactory

 2. Able to implement and administer an accounting system (Budgeting, Cash Receipts, Petty Cash, Cash Disbursements, Bank                                       Check one                 Circle one
    Reconciliation, Bank Accts., General Fixed Asset, Chart of Accts., Payroll, Taxes/Liabilities, Travel, Resale Inventory, Financial                            Critical                5 Outstanding
                                                                                                                                                                                          4 Significantly exceeds standards
    assistance, Financial Statements, and Audit Requirements) to adequately account and safeguard for all financial resources that                                                        3 Meets standards
    meet all Navajo Nation regulatory requirements (daily, weekly, monthly or quarterly) such as chapter FMS and Accounting,                                                              2 Does not fully meet standards
    Coordination, Reporting and Monitoring Policy. As custodian of chapter management and responsibilities to prevent misuse of                                     Secondary             1 Unsatisfactory
    chapter funds or assets.
 3. Able to implement a procurement control system (good/services) that is capable to ensure the most cost effectiveness of                                     Check one                 Circle one
                                                                                                                                                                  Critical                5 Outstanding
    allocated funds and adheres to the guidelines established in the Conditions of Appropriations and NN Procurement Act.                                                                 4 Significantly exceeds standards
                                                                                                                                                                    Major                 3 Meets standards
                                                                                                                                                                                          2 Does not fully meet standards
                                                                                                                                                                    Secondary             1 Unsatisfactory

 4 Able to implement a property management system (Property Acquisition, Identification, Classification/Records, Physical                                       Check one                 Circle one
                                                                                                                                                                  Critical                5 Outstanding
   Inventory, Lost/Stolen or Damaged Property, Maintenance and Storage, Rental & Utilization of Chapter Property, Property &                                                              4 Significantly exceeds standards
   Equipment Insurance and Property Disposition) to govern the accounting of all chapter property and records through the                                           Major                 3 Meets standards
   maintenance of inventory procedures for financial reporting (daily or yearly).                                                                                                         2 Does not fully meet standards
                                                                                                                                                                    Secondary             1 Unsatisfactory
RATING SUPERVISOR COMMENTS:                                                                                                                                                               Circle one
                                                                                                                                                                    OVERALL               5 Outstanding
                                                                                                                                                                   RATING ON              4 Significantly exceeds standards
                                                                                                                                                                    MEETING               3 Meets standards
                                                                                                                                                                   OBJECTIVES             2 Does not fully meet standards
                                                                                                                                                                                          1 Unsatisfactory
                                                                                                                                                                     PART I.
5 - OUTSTANDING          4 - SIGNIFICANTLY EXCEEDS STANDARDS 3 - MEETS STANDARDS                                                                                             1
                                                                                                                                              2 -DOES NOT FULLY MEET STANDARDS - UNSATISFACTORY
Regularly makes exceptional contrib-     Frequently exceeds performance                           Consistently meets job standards and        Has not consistently met job requirements           Consistently performs in an
utions that have a materially positive   expectations/ objectives, accomplishments are            may occasionally exceed performance         and occasionally demonstrates                       unsatisfactory manner. Employee does
impact on department,                    clearly and frequently above what is required.           expectations or objectives.                 unsatisfactory performance. May have the            not meet most established performance
accomplishments are unique,                                                                       Consistently performs in a reliable and     ability to complete most assignments,               requirements.
exceptional and significant.                                                                      professional manner.                        however, immediate improvement is
Consistently exceeds all job                                                                                                                  necessary.
CRITICAL:Must be met or exceeded for program to meet its objective               MAJOR: Must be met for individual to be effective              SECONDARY: Should be met but will not preclude individual/program effectiveness

  Revised: April 28, 2004                                                                                        Page 1 of 5

              PART II                                         REVIEW OF PROGRESS TOWARD MEETING STANDARDS OF PERFORMANCE - EXEMPT
 PLANNING & ORGANIZING: Consider planning and organization skills, priorities, time usage, short and long term planning.
 Exceptional planning and organization, sets Plans and organizes very well, consistently    Good planning and organization skills.                    Planning and organizing need                    Fails to adequately plan and organize,
 priorities, encourages and promotes optimal sets priorities, use of time is very good,     Good use of time, will generally set and                  improvement, use of time not very               inefficient use of time, fails to set or
 use of time, schedules activities, sets and consistently sets and maintains timelines.     maintain timelines.                                       efficient, does not always set or               maintain any timelines for activities.
 maintains timelines.                                                                                                                                 maintain timelines for activities.

                      5                                                   4                                             3                                              2                                               1
 JUDGMENT: Consider ability to understand consequences, options, level of difficulty, and results of decision making.
 Outstanding judgment, considers                    Very good judgment, considers                      Good judgment, usually considers               Seldom applies good judgment. Often             Judgment often wrong or ineffective.
 alternatives, consistently makes timely            alternatives, makes timely and correct             alternatives, requires some assistance         does not consider alternatives, usually         Will not consider alternatives, fails to
 and correct decisions even on complex              decisions in most situations that do not           with decision making.                          requires supervision in making decisions.       make timely or correct decisions.
 matters.                                           involve complex issues.                                                                                                                           Work has to be corrected.

                      5                                                  4                                             3                                              2                                               1
 DEPENDABILITY:                  Consider both attendance and punctuality in following through on assigned schedule of work hours.
 Outstanding attendance and punctuality.            Very good attendance and punctuality, can be       Good attendance and punctuality, usually can   Frequently absent from work and/or tardy,       Attendance is poor, consistently takes
                                                    counted on to be on the job and ready to work on   be relied on to be on the job and ready to     inconsistent in being on the job and ready to   extended breaks and/or lunch, fails to be
                                                    time.                                              work.                                          work.                                           on the job and ready to work.

                      5                                                 4                                              3                                              2                                               1
 JOB KNOWLEDGE:                  Consider understanding of principles, methods, and processes used; experience and training to handle job competently.
 Thoroughly informed. Knows all aspects of job.     Well informed, seldom needs assistance or          Knowledge sufficient to perform primary job    Knowledge is not sufficient to do job well.     Not informed or knowledgeable to do job.
                                                    guidance on job duties and responsibilities.       duties and responsibilities.                   Frequently requires assistance or guidance on   Requires constant assistance and
                                                                                                                                                      job duties and responsibilities.                guidance on duties and responsibilities,
                                                                                                                                                                                                      limited to simplest duties.

                      5                                                   4                                            3                                              2                                                1
 QUALITY OF WORK:                  Consider work free of errors, ability to detect errors, consistent conformance to specification.
 Work consistently exceeds requirements. Very            Displays skill. Usually exceeds               Usually does a satisfactory job. Quality       Sometimes makes too many mistakes. Work         Unsatisfactory, does not meet requirements. Work
 few errors.                                             requirements. Few errors.                     meets standards.                               needs checking.                                 consistently has too many mistakes and is often

                      5                                                 4                                              3                                              2                                               1

Revised: April 28, 2004                                                                                                      Page 2 of 5
           PART II. (Continued)                                           REVIEW OF PROGRESS TOWARD MEETING STANDARDS OF PERFORMANCE- EXEMPT
    PRODUCTIVITY:                       Consider consistency, follow through on projects/tasks, timeliness, adherence to schedules. Ability to work without constant supervision.
    Assignments consistently accurate, complete, on        Completes most assignments accurately and      Completes assignments satisfactorily,        Very little productivity, at times requires               Rarely completes assignments, wastes
    time, requires little to no supervision, finds other   on time, minimum supervision required, asks    efficient use of time, some supervision      additional supervision, work must be                      time, requires constant supervision.
    work to do.                                            for other work to do.                          required.                                    assigned.

                           5                                                   4                                          3                                             2                                                        1
                                                Consider sharing information & resources, developing effective working relationships, developing consensus, managing conflict, etc.

    Takes initiative, goes all out to cooperate with       Promotes cooperation, good team worker.        Works smoothly wiith others, follows         Does not always promote cooperation,                      Uncooperative, does not work well with
    others, helps co-workers.                                                                             suggestions to help.                         sometimes has difficulty working with others,             others, often creates conflict.
                                                                                                                                                       has to be directed to help.

                           5                                                   4                                          3                                             2                                                         1
    ADAPTABILITY:                               Consider ability and quickness to learn, adjust and apply techniques to assignments and situations.
    Learns very rapidly, highly adaptable and              Consistently able to grasp new ideas and       Adjusts to change with minimum               Slow to adapt to new situations or tasks,                 Not adaptable to new methods or duties,
    responds positively to change.                         retain information, adapts and responds well   difficulty, generally grasps new ideas and   often does not grasp or is forgetful of                   fights change.
                                                           to change.                                     retains information.                         assignments.

                           5                                                   4                                          3                                             2                                                         1

                           5                                                   4                                          3                                              2                                                        1

    SUPERVISOR COMMENTS:                                                                                                                                                                                             Circle one:
                                                                                                                                                                                            OVERALL RATING            5 Outstanding
                                                                                                                                                                                              ON MEETING              4 Significantly exceeds standards
                                                                                                                                                                                             STANDARDS OF             3 Meets standards
                                                                                                                                                                                             PERFORMANCE              2 Does not fully meet standards
                                                                                                                                                                                                     PART II.         1 Unsatisfactory

                                                                                             OVERALL RATING (For Part I. and Part II. Combined)
                         OUTSTANDING                                SIGNIFICANTLY                                  MEETS                                 DOES NOT FULLY                                         UNSATISFACTORY
                                                                       EXCEEDS                                   STANDARDS                               MEET STANDARDS
                                    5                                          4                                          3                                             2                                                  1

Revised: April 28, 2004                                                                                                       Page 3 of 5
          EMPLOYEE PEFORMANCE APPRAISAL FORM - EXEMPT                                                                                                                        NAME:

  PART III     EMPLOYEE STATEMENT (OPTIONAL - Additional sheets of paper may be used)


  I hereby acknowledge that this Performance Appraisal form has been reviewed with the employee and that performance objectives have been established for the next appraisal period.

  Supervisor (Type or Print)                       Title                                                                 Signature                                                               Date

  I hereby acknowledge that this Performance Appraisal has been reviewed with me and I also understand that signing this Appraisal form does not necessarily imply agreement with the content.

  Employee (Type or Print)                         Title                                                                 Signature                                                               Date

   Reviewing Official (Type or Print)               Title
                                                   Title                                                                 Signature                                                               Date

Revised: April 28, 2004                                                                                           Page 4 of 5
              SUPPLEMENTAL - PERFORMANCE OBJECTIVES - EXEMPT                                      NAME
        5.                                                                                                       Check one      Circle one
              Ensure to implement and administer a personnel management system, including an approved
                                                                                                                    Critical     5 Outstanding
              chapter public employment project, and proper management within the guidelines established by                      4 Significantly exceeds standards
              the chapter membership.                                                                               Major        3 Meets standards
                                                                                                                                 2 Does not fully meet standards
                                                                                                                    Secondary    1 Unsatisfactory
        6.                                                                                                       Check one      Circle one
              Able to implement a record management system to provide for the creation, maintenance,
                                                                                                                    Critical     5 Outstanding
              retention, protection, control and disposal of Chapter documents and records. The NN Privacy                       4 Significantly exceeds standards
              Access & Information Act are being addressed to the public, community membership, in                  Major        3 Meets standards
              accordance to the policies and applicable laws.                                                                    2 Does not fully meet standards
                                                                                                                    Secondary    1 Unsatisfactory
        7.                                                                                                       Check one      Circle one
              Able to managed and ensure all reporting requirement are met on Capital Infrastructural Projects
                                                                                                                    Critical     5 Outstanding
              that are funded under Abandonment Mine Land, Capital Improvement, Community Development                            4 Significantly exceeds standards
              Block Grant, State Projects, and other grantors.                                                      Major        3 Meets standards
                                                                                                                                 2 Does not fully meet standards
                                                                                                                    Secondary    1 Unsatisfactory


                  5                           4                            3                        2                                  1

                  5                           4                            3                        2                                  1

                  5                           4                            3                        2                                  1

Revised: April 28, 2004                                                        Page 5 of 5

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