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PER126ClericalServiceRating - PER-126_Clerical_Service_Rating_Word_6

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State of Connecticut Human Resources
Performance Appraisal - Administrative-Clerical
Form #: PER-126
Revision Date: 9/23/2003
This form provided by the Department of Administrative Services
________________________________________________________________________________________________________
_
Period Covered: From To
INITIAL PROBATIONARY ANNUAL PROMOTIONAL OTHER (Specify)
EMPLOYEE NAME TITLE DATE
DIVISION DEPARTMENT
INSTRUCTIONS
Evaluate the employee on the job now being performed. Check the box above the horizontal line that most nearly coincides with
your overall judgment of each quality. The care and accuracy with which this appraisal is made will determine its value to you, to
the employee and to the agency.
LESS THAN GOOD
JOB ELEMENTS EXCELLENT VERY GOOD GOOD FAIR UNSATISFACTOR
Y
KNOWLEDGE OF
WORK:
Consider knowledge of
job gained through
experience, general
education, specialized
training
Well informed
on all phases of
work
Knowledge
thorough enough
to perform
without
assistance
Adequate grasp
of essentials,
some assistance
Requires
considerable
assistance
Inadequate knowledge
QUANTITY OF WORK:
Consider the volume of
work produced under
normal conditions.
Disregard errors.
Rapid worker
unusually large
volume
Turns out large
volume
Average Volume below
average
Very slow worker
QUALITY OF WORK:
Consider neatness
accuracy and
dependability of results
regardless of volume
Exceptionally
accurate
Seldom necessary
to check work
Acceptable,
usually neat, few
errors
Often
unacceptable.
Frequent errors
or rejections
Too many errors or
rejections
ATTENDANCE
Consider tardiness and
occasions of absenteeism
Rarely late,
rarely absent
Very seldom late,
seldom absent
Seldom late,
absent only
occasionally
Frequently tardy
or routinely
absent
Habitually tardy or
excessive absenteeism
ABILITY TO DEAL
WITH PEOPLE
Relationships with other
staff and the public.
Consider harmony in and
outside the work unit.
Brings credit to
state service
through
cooperative
dealings with
staff and public
Harmonious
relationships with
staff and/or
public
Adequate work
relationships with
staff and/or
public
Reluctant to
cooperate with
staff and/or
public
Creates problems
through personal
interaction with staff
an/or public
State of Connecticut Human Resources
Performance Appraisal - Administrative-Clerical
Form #: PER-126
Revision Date: 9/23/2003
This form provided by the Department of Administrative Services
OTHER ELEMENTS: Consider other elements of job performance that are not included but are job related, i.e. problem
solving, supervisory ability, dependability, judgment etc.
EXCELLENT VERY GOOD GOOD FAIR UNSATISFACTORY
OVERALL EVALUATION
EXCELLENT Excellent in all elements
VERY GOOD No fair elements and majority of items rated very good or better
GOOD
Most elements rated good or one element rated fair
FAIR No unsatisfactory elements 2 or more elements rated fair
UNSATISFACTORY One or more elements rated unsatisfactory
COMMENTS (Instructions): Comments are encouraged on all elements of performance, but are required on only those
elements rated FAIR OR UNSATISFACTORY
SIGNATURE TITLE DATE
RATED BY:
SIGNATURE TITLE DATE
REVIEWED BY:
SIGNATURE TITLE DATE
APPROVED BY:
SIGNATURE TITLE DATE
EMPLOYEE:
NOTE TO EMPLOYEE: Your signature confirms that you have seen this report and discussed it with your supervisor. It does not indicate
your agreement
. Page 2
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