CERTFICATION BY RATER
I hereby certify that this report constitutes my best judgment of the job performance of this employee and is based on personal
knowledge of his/her work. If the employee has worked under my supervision for less than three months, I certify that I have
discussed the employee’s performance with the previous supervisor and that the employee’s performance under this supervisor is
reflected in the appraisal.
Signature of Rater: __________________________________Title:_______________________________ Date: _________________
CERTFICATION BY REVIEWER
I hereby certify that I have carefully reviewed this report and informed the rater of any inconsistencies/errors noted and/or lack of
required documentation as given on this form. I understand that if I do not agree with an assigned rating, I can discuss my
disagreement with the rater and use the comments section below to state my disagreement.
Signature of Reviewer: __________________________________Title:____________________________Date:__________________
REVIEW BY DEPARTMENT DIRECTOR
Signature of Director: ______________________________________________________ Date: ___________________
REVIEW BY EMPLOYEE
I hereby certify that I have received a copy of this performance evaluation and that it has been discussed with me. If I disagree with
the evaluation, I will use the comments section below to state my complaints.
Signature of Employee __________________________________Title:____________________________Date:__________________
REVIEW BY HUMAN RESOURCES DIRECTOR
I hereby certify that I have received this report and noted any inconsistencies/errors.
Signature of Human Resources Director: ________________________________________ Date: ___________________