(Please do not staple or paper clip)
Name:
Title:
Review Period:
Due:
CITY OF HICKORY
PERFORMANCE PAY RECOMMENDATION
UNACCEPTABLE: Performance is inconsistent and does not meet requirements in one or
more areas. Remedial action and close supervision are required. Significant improvement must
occur or termination of employment could result.
(No salary increase, IMPROVEMENT PLAN MUST BE ENCLOSED)
MEETS JOB REQUIREMENTS: Performance meets requirements established for the job in
all or most areas. The coworker does a capable job of providing services that are required and
expected from the position. Most coworkers perform at this level.
EXCEEDS JOB REQUIREMENTS: Performance clearly exceeds most or all work requirements.
Work is performed at a high level of proficiency, skill, and quality throughout the evaluation period.
Work is accomplished with a minimum of supervision. To receive an Exceeds Job Requirements,
the performance must be rated as exceeds in at least 3 of the 5 categories.
I acknowledge that I have had an opportunity to discuss this review with my supervisor. I understand that
signing this form does not necessarily imply agreement with my supervisor’s rating and that I may write my
comments below or attach additional sheets of paper to explain any comments.
Employee’s Signature: ____________________________________ Date: ____________
Comments:
Supervisor’s Signature: ____________________________________ Date: ____________
Comments:
Department Head’s Signature: _______________________________ Date: ____________
Comments: