New Mexico Department of Labor

22222
2004

EMPLOYEE DEVELOPMENT AND APPRAISAL SUMMARY

Incumbent Information
(PRINT or TYPE)

NAME: SSN:

CLASSIFICATION: TOOL#:

DIVISION: COST CENTER NAME: COST CENTER NO:

IMMEDIATE SUPERVISOR:
(Supervisor of record on Tool in effect as of mail date)

Appraisal Period
BEGIN DATE: END DATE:

SPB FORM USED (EDA, EDA Addendum or other approved form):

COMMENTS:

Summary Evaluation
(CHECK APPROPRIATE BOX, and also enter appropriate Final Appraisal Rating letter on Page 2 of the EDA form)
E—Exceptional

S—Successful

R—Requires Attention

N—Not Acceptable

I certify that I have completed a Employee Development and Appraisal for the above-named employee for the specified appraisal period. The Summary Evaluation
rating indicated above represents my best assessment of this individual’s performance during this period and is fully substantiated and documented on an approved SPB
Form in accordance with Rule 9.1.

SIGNED (Immediate Supervisor): Date:

I certify that I have had my performance appraised and documented on an approved SPB Form during the subject appraisal period and that the Summary Evaluation
rating given above is the same as that documented on the approved form. I understand that my signature does not necessarily indicate agreement with my supervisor’s
assessment of my performance and that I may submit a rebuttal to the performance appraisal.

SIGNED (Incumbent): Date:

SIGNED (Bureau Chief): Date:

SIGNED (Division Director): Date:

SIGNED (Department Secretary): Date:

This EDA form must be returned to HRB