Annual Performance Evaluation Form

Non-Probationary Classified Employees

To increase the number of boxes to match the number of core responsibilities, save the form to your desktop. You may then open it, unprotect document, copy and paste additional cells, then re-number the cells.

Employee Name:	Employee ID #: Position #:
Department:	Date prepared:

Core Responsibilities, Special Assignments and Departmental Values

Core Responsibility	Core Responsibilities
1	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments
2	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments
3	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments

Core Responsibility	Core Responsibilities Continued
4	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments
5	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments
6	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments

Special Assignments
Special Assignments	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments

Departmental Values
Departmental Values	Below Contributor Moderate Contributor Contributor High Contributor Extraordinary Contributor
Positive Factors	Areas For Improvement
Additional Comments

Overall Results and Rating

An Acknowledgement of Extraordinary Contribution or a Notice of Improvement Needed must be attached to the Annual Performance Evaluation to support an overall rating of Extraordinary or Below Contributor. (A Written Notice issued during the performance cycle will be on file in Human Resources, and may also be used in support of an overall rating of Below Contributor on the Annual Performance Evaluation.)

Extraordinary Contributor Acknowledgement of Extraordinary Contribution form attached?	Performance shows sustained, exemplary accomplishment throughout the rating period. Performance is well above the criteria of the job function. (At least one Acknowledgement of Extraordinary Contribution must be attached.)
High Contributor	Performance shows a consistently high level of accomplishment, often exceeding performance targets.
Contributor	Performance shows consistent achievement toward meeting established performance expectations.
Moderate Contributor	Performance shows inconsistent achievement toward meeting minimum standards for the position. Expectations were not met consistently.
Below Contributor Notice of Improvement Needed form attached? Improvement Plan attached?	Performance shows deficiencies that interfere with the attainment of performance expectations. (At least one Notice of Improvement Needed form must be attached or at least one Written Notice be on file. A specific improvement plan must be attached.)

Signatures

Supervisor’s Comments:
Supervisor’s Signature:	Employee ID #:	Date:
Supervisor’s Name Printed:	Position #:
Reviewer’s Comments:
Reviewer’s Signature:	Employee ID #:	Date:
Reviewer’s Name Printed:	Position #:
Employee Comments: (Check the box below only if it applies.) I was not given an opportunity to provide a self-evaluation.
Employee’s Signature:	Employee ID #:	Date:
Employee’s Name Printed:	Position #:

The form original is submitted to Human Resources, MSC 7009, no later than 5:00 p.m. on the last workday in September. A copy of the evaluation is given to the employee. A copy of the evaluation is also retained in the departmental files.