EMPLOYEE WORK PROFILE WORK DESCRIPTION/PERFORMANCE PLAN

[Parts I and II should be used alone to establish a new position and/or to change a positions duties and responsibilities. Parts I through IV should be completed annually between September 1 and December 31 discussed with the employee and retained in the departments !iles. Parts V through I" must be used to conduct the annual e#aluation and then the entire $%P must be submitted to &ni#ersity 'uman (esources to complete the annual e#aluation process.)

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P!RT I " Positio# Ide#tific$tio# I#form$tio# %&

U#i'& of (! )*+,U#i'& of (!.s /olle0e $t ise )*12Southwest (! Hi0her 3d /e#ter )415-

*& School67ept8 Position 4umber6 Incumbents 4ame6 Incumbents ID6 (ole *itle +'( &se.6

Or0 /ode8

9& Positio# I#form$tio#8

(ole 5ode +'( &se.6 %or3 *itle6

Pay 7and 1e#el +'( &se.6 1& Super'isor I#form$tio#8 Super#isors 4ame6 Super#isors ID6 Super#isors *itle6

Super#isors (ole 5ode +'( &se.6

Super#isors Position 4umber6

:& Positio# Le'el I#dic$tor6 $mployee Super#isor 8anager $mployees Super#ised6 Does employee super#ise 9 or more employees +:*$s.; <es 4o ,& 3ffecti'e 7$te8

2& FLS! St$tus )HR Use): $-empt 4on=$-empt $-emption/Partial $-emption *est +i! applicable.6 5& Occup$tio#$l F$mily ; /$reer Group (HR Use)8 %+& SO/ Title ; /ode (HR Use):

Statement o! $conomic Interests (e>uired; (HR Use) <es 4o 4& 33O /ode (HR Use):

P!RT II "
%& Or0$#i=$tio#$l O>?ecti'e8

or< 7escriptio# $#d Perform$#ce Pl$#

[7rie! statement o! how the position relates to the wor3 unit di#ision or agencys ob?ecti#es.)

*& Purpose of Positio#8

employee in this position.) [@ statement e-plaining why the position e-ists. Speci!y the most important ser#ice or product e-pected !rom the

3. @S!.s $#d6or /ompete#cies reAuired to successfully perform the wor<8

[Describe the e-pertise re>uired to success!ully per!orm the assigned wor3. Pro#ide a narrati#e o! at least three +3. AS@s/competencies but not more than !i#e +B. that are re>uired to per!orm the wor3.) [State the educational bac3ground that is minimally re>uired and/or pre!erred and list any occupational certi!ications or licenses that the employee must hold.)

C. 3duc$tio#B 3Cperie#ceB Lice#sureB /ertific$tio# reAuired for e#try i#to positio#8

:& Le'el of I#depe#de#t !cti'ity [State the wor3 actions and/or decisions the employee ma3es without prior appro#al.
State to what e-tent the employee recei#es ad#ice and guidance !rom the super#isor. State e-amples o! the type o! super#isory ad#ice and guidance that is gi#en as well as actions or decisions the employee ma3es without prior appro#al.)

2& /o#t$cts of Positio# [1ist and e-plain the contacts the employee has both inside and outside the State Do#ernment
!unction o! the wor3. Do not list contacts with super#isors co=wor3ers and subordinates.) i! any as a routine

Perso#s or Or0$#i=$tio#

Purpose

How Ofte#

I#side6OutsideSt$te Go'.t

$mployees Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Print 4ame6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEE Super#isors Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Print 4ame6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEEE 'a#e the duties and responsibilities o! this position recently changed; <es 4o

!TT!/H " ORG!NID!TION!L /H!RT

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Perform$#ce Pl$#
E Time

,& Respo#si>ilities
[1ist in order o! importance the ma?or duties or !unctions which are primary and essential to the position. Statements in the section should be concise.)

5& Me$sures for Respo#si>ilities

[Identi!y the >ualitati#e >uantitati#e and timeliness measures against which each responsibility will be assessed.)

@. Per!ormance 8anagement +!or all employees who super#ise others.

Me$sures for Perform$#ce M$#$0eme#t6 Insures that e-pectations are clear well communicated and relate to the goals and ob?ecti#es o! the department or unit Insures that sta!! recei#e !re>uent constructi#e !eedbac3 including interim e#aluations as appropriate Insures that sta!! ha#e the necessary 3nowledge s3ills and abilities to accomplish goals Insures that the re>uirements o! the per!ormance planning and e#aluation system are met and e#aluations are completed by established deadlines with proper documentation Insures that per!ormance issues are addressed and documented as they occur 5onsistently stri#es to insure a sa!e wor3 en#ironment through education assessment and the demonstrated obser#ance o! sound sa!ety practices and !urther demonstrates commitment to reducing lost time by supporting the sa!e resumption o! wor3 by employees with wor3=related or non=wor3 related illnesses or in?uries.

F F F F F 4/@

7. 5. D. $. :. D. 8ay be re>uired to per!orm other duties as assigned. 8ay be re>uired to assist the agency or state go#ernment generally in the e#ent o! an emergency declaration by the Do#ernor.

____ 100%
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4& Physic$l 7em$#ds /hec<list

Positio# Num>er8

5omplete each physical demand by indicating in the bo- whether the physical demand is6 5 G constant : G !re>uent 0 G occasional 4Gne#er

1ight li!ting +H9I lbs..

Sitting +!or sustained periods o! time.

Subject to hazard uch a !

8oderate li!ting +9I=BI lbs..

%al3ing +mo#ing about on !oot to accomplish tas3s.

%or3ing with electrical current

'ea#y li!ting +JBI lbs..

(epetiti#e motion +sustained mo#ements/motions o! the wrists hand and/or !ingers.

Working on scaffolding and high places Exposure to high heat

Standing +!or sustained periods o! time.

7ending

Reaching (extending hand(s) and arm(s) in any direction)

Pushing pulling

!thers" specify#

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EMPLOYEE WORK PROFILE 3MPLOF33 L3!RNING6/!R33R 73(3LOPM3NT PL!N

[*his !orm should be updated annually +no later than December 31. a!ter completion o! the annual per!ormance e#aluation and retained in a con!idential departmental employee !ile.)

P!RT III " 3mployee Le$r#i#06/$reer 7e'elopme#t Pl$#

%& Perso#$l Le$r#i#0 Go$ls [1ist any learning goals identi!ied by the employee and/or by the super#isor and speci!y who has listed the goal.
Doals should be rele#ant to the current duties and responsibilities o! the employee and or to !uture career growth in the current or a related !ield

*& Le$r#i#0 Steps6Resource Needs

include training coaching or other learning methods.) [1ist speci!ic steps that need to be ta3en and by whom to accomplish the learning goals. *his may

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P$rt I( " Re'iew6!c<#owled0eme#t of 3mployee Perform$#ce $#d Le$r#i#0 Pl$#

3mployee.s /omme#ts8 G$tt$ch $dditio#$l sheets if #ecess$ryH
Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
[Signature represents that the Plan was discussed with the employee but does not necessarily constitute agreement with the Plan. Super#isor should initial the $mployee Section to indicate that the Plan was discussed i! the employee does not sign.)

Print 4ame6EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

Super'isor.s /omme#ts8 G$tt$ch $dditio#$l sheets if #ecess$ryH

Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEE Print 4ame6EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

Re'iewer.s /omme#ts6 G$tt$ch $dditio#$l sheets if #ecess$ryH

Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEE Print 4ame6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

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EMPLOYEE WORK PROFILE P3RFORM!N/3 3(!LU!TION

[*his !orm must be completed and returned to &'( at K1C $mmet Street 8ichie South P.0. 7o- CII19L 5harlottes#ille V@ 99KIC=C19L.)

P!RT ( " 3mployee6Positio# Ide#tific$tio# I#form$tio#

Positio# Num>er6 !0e#cy N$me ; !0e#cy /odeI 7i'isio#67ep$rtme#t6

3mployee N$me6

3mployee I78

P!RT (I " 3mployee Perform$#ce 3'$lu$tio# *& Respo#si>ilities J /omme#ts o# Results !chie'ed
[Describe the employees per!ormance including any documentation to support the earned rating.)

%& Respo#si>ilities J R$ti#0 3$r#ed

[5hec3 the appropriate rating earned by the employee during the per!ormance cycle.) !& $-traordinary 5ontributor 5ontributor K& 7elow 5ontributor $-traordinary 5ontributor 5ontributor 7elow 5ontributor /& $-traordinary 5ontributor 5ontributor 7elow 5ontributor 7& $-traordinary 5ontributor 5ontributor 3& 7elow 5ontributor $-traordinary 5ontributor 5ontributor F& 7elow 5ontributor $-traordinary 5ontributor 5ontributor G& 7elow 5ontributor $-traordinary 5ontributor 5ontributor 7elow 5ontributor

Perform$#ce M$#$0eme#t )for $ll employees who super'ise others-8

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$-traordinary 5ontributor 5ontributor 7elow 5ontributor

3. 0ther pro?ects/accomplishments during the rating period not described abo#e [optional rating).

C. Describe !actors beyond indi#idual and/or organi,ation control during this per!ormance cycle which may ha#e a!!ected per!ormance

P$rt (II J 3mployee Le$r#i#06/$reer 7e'elopme#t Results Fe$rJe#d Le$r#i#0 !ccomplishme#ts8 GSumm$ri=e $ccomplishme#ts rel$ted to the perso#$l le$r#i#0 0o$ls
th$t were set $t the >e0i##i#0 of the cycle&H

P$rt (III J O'er$ll Results !ssessme#t $#d R$ti#0 3$r#ed

G/hec< the $ppropri$te o'er$ll r$ti#0 e$r#ed >y the employee duri#0 the perform$#ce cycle&H

@n employee recei#ing an o#erall rating o! M7elow 5ontributorM must ha#e recei#ed at least one 4otice o! Impro#ement 4eeded/Substandard Per!ormance !orm during the per!ormance cycle. @n employee who earns an o#erall rating o! /7elow 5ontributor2 must be re#iewed again within three months. @n employee recei#ing an o#erall rating o! M$-traordinary 5ontributorM must ha#e recei#ed at least one @c3nowledgment o! $-traordinary 5ontribution !orm during the per!ormance cycle. 'owe#er the receipt o! an @c3nowledgment o! $-traordinary 5ontribution !orm does not guarantee an o#erall per!ormance rating o! /$-traordinary 5ontributor2 !or that per!ormance cycle.
O'er$ll R$ti#0 3$r#ed

$-traordinary 5ontributor 5ontributor 7elow 5ontributor

P$rt IL J Re'iew of Perform$#ce 3'$lu$tio# Super'isor /omme#ts8

GThe Super'isor must si0# prior to su>mitti#0 to the Re'iewer for $ppro'$l $#d c$##ot discuss with the employee u#til the Re'iewer si0#s&H

Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Print 4ame6EEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEEEEEEEEEEEEEEEEEEE

Re'iewer /omme#ts8
GThe Re'iewer must si0# prior to the Super'isor.s prese#t$tio# of the e'$lu$tio# to the employee&H

Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Print 4ame6EEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEEEEEEEEEEEEEEEEEEE

3mployee /omme#ts8
GThe 3mployee si0#s o#ly $fter the Super'isor $#d the Re'iewer h$'e si0#ed the e'$lu$tio#&H

Signature6 EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Print 4ame6EEEEEEEEEEEEEEEEEEEEEEEEEE Date6 EEEEEEEEEEEEEEEEEEEEEEEEEE

'a#e the duties and responsibilities o! the position changed during this per!ormance e#aluation cycle; <es 4o

)PL3!S3 !TT!/H ORG!NID!TION!L /H!RT K3LO 40*$6 *his !orm must be unprotected to attach a chart. Please select *ools/&nprotect Document. @ password is not necessary.