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
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