Fillable PE Final Draft 7-15-08 ARKANSAS TECH UNIVERSITY

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PE Final Draft 7-15-08 ARKANSAS TECH UNIVERSITY

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Employee Performance Evaluation Form Page 1 of 4
ARKANSAS TECH UNIVERSITY
Human Resources Office, Bryan Hall
Russellville, AR 72801
Phone: (479) 968-0396 - Fax: (479) 968-0693
EMPLOYEE PERFORMANCE EVALUATION FORM
Name (Last, First, MI)
T Number
Position Number
Position Title
Department
Rating Period
From ____________ to ____________
Date of Evaluation
Name of Rater (Last, First, MI)
Telephone Number
Position Title
Name of Reviewing Official (Last, First, MI)
Telephone Number
Position Title
RELATIVE IMPORTANCE SCALE
A = Primary job responsibility - representing the majority of the work load.
B = Secondary job responsibility - representing minority of the work load.
C = Tertiary job responsibility - representing minimal portion of work load.
PERFORMANCE CATEGORY RATING SCALE
E = EXCEEDS STANDARD – An overall evaluation which demonstrates
performance of the duties and responsibilities of the job at a level exceeding
that of an above average evaluation.
AA = ABOVE AVERAGE - An overall evaluation which demonstrates
performance of the duties and responsibilities of the job at a level exceeding
that of a satisfactory evaluation.
S = SATISFACTORY – An over overall evaluation which demonstrates
competency in the performance of the duties and responsibilities of the job.
U – UNSATISFACTORY – An overall performance of duties that is
unacceptable in quality, accuracy, and timeliness.
PERFORMANCE EVALUATION SUMMARY
Summarize the performance evaluation by listing the duty area numbers, summary statements, relative importance indicators, and duty area ratings below.
DUTY
AREA
NUMBER
RELATIVE
IMPORTANCE
(A, B, OR C)
DUTY AREA RATING
(E, AA, S, OR U)
1
2
3
4
5
6
7
Overall Performance Evaluation Rating
EMPLOYEES NAME
SSN
T#
NAME OF RATER
DATE OF EVALUATION
Employee Performance Evaluation Form Page 2 of 4
IDENTIFICATION OF DUTIES
Tasks Assigned
Duty Area #1
Performance Indicator(s)
Tasks Assigned
Duty Area #2
Performance Indicator(s)
Tasks Assigned
Duty Area #3
Performance Indicator(s)
Tasks Assigned
Duty Area #4
Performance Indicator(s)
Tasks Assigned
Duty Area #5
Performance Indicator(s)
Tasks Assigned
Duty Area #6
Performance Indicator(s)
Tasks Assigned
Duty Area #7
Performance Indicator(s)
EVALUATION OF DUTIES
Duty Area #1
Summary, Standard, Method of Monitoring, and Results
Relative
Importance
Rating
Summary Statement:
Standard:
Method of Monitoring:
Results:
Duty Area #2
Summary, Standard, Method of Monitoring, and Results
Relative
Importance
Rating
Summary Statement:
Standard:
Method of Monitoring:
Results:
EMPLOYEES NAME
SSN
T#
NAME OF RATER
DATE OF EVALUATION
Employee Performance Evaluation Form Page 3 of 4
Duty Area #3
Summary, Standard, Method of Monitoring, and Results
Relative
Importance
Rating
Summary Statement:
Standard:
Method of Monitoring:
Results:
Duty Area #4
Summary, Standard, Method of Monitoring, and Results
Relative
Importance
Rating
Summary Statement:
Standard:
Method of Monitoring:
Results:
Duty Area #5
Summary, Standard, Method of Monitoring, and Results
Relative
Importance
Rating
Summary Statement:
Standard:
Method of Monitoring:
Results:
Duty Area #6
Summary, Standard, Method of Monitoring, and Results
Relative
Importance
Rating
Summary Statement:
Standard:
Method of Monitoring:
Results:
Duty Area #7
Summary, Standard, Method of Monitoring, and Results
Relative
Importance
Rating
Summary Statement:
Standard:
Method of Monitoring:
Results:
EMPLOYEES NAME
SSN
T#
NAME OF RATER
DATE OF EVALUATION
Employee Performance Evaluation Form Page 4 of 4
At the beginning of the rating period after the standards have been established, complete the following section.
I have reviewed the standards established above and understand my performance will be measured against them.
Employee’s Signature: Date:
The standards listed above were established at the beginning of the rating period in consultation with the employee named above.
Rater’s Signature: Date:
I have reviewed the standards established above and agree that they are appropriate for the position.
Reviewing Official’s Signature: Date:
At the end of the rating period when the evaluation is scored and reviewed with the employee, complete the following section.
By signing below, the employee concurs only that the performance evaluation has been conducted. The employee’s signature does not indicate
that he or she agrees with the evaluation. Comments concerning performance may be submitted on a separate sheet.
Employee’s Signature: Date:
By signing below, the supervisor certifies that all subordinate performance evaluations have been completed and forwarded to the reviewing official.
Rater’s Signature: Date:
By signing below, the reviewing official certifies that the employee’s performance evaluation and all attachments have been reviewed.
Reviewing Official’s Signature: Date:
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PE Final Draft 7-15-08 ARKANSAS TECH UNIVERSITY

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Completed 8 March 2020

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