A Sample Self-Assessment

Annual Performance Evaluation Form

Non-Probationary, Classified Employees
Employee Name:
Jane Smith
PeopleSoft ID#: 100012345 Position #: 00044
Department:
English Department
Date prepare:
!"g"st 5# 200$
Core Responsibilities, Special Assignments & epartmental !alues
Core
Responsibility
Evaluation
1
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Positi*e +a,tors !reas +or Impro*ement
In my s"per*ision of -ate# the .ffi,e Ser*i,es
!ssistant# I ha*e o&ser*e that she has learne her
position *ery /"i,0ly1 She has tol me often that she
feels en,o"rage in her 2o& an o"r )or0ing
relationship1 !ll performan,e management ealines
ha*e &een or are &eing met1
I nee to help -ate more on the te,hni,al aspe,t of her
2o& an ho) it fits into the &ig pi,t"re1
Additional Comments
I3 li0e to "pate -ate3s position es,ription to in,l"e st"ent4epartment s,he"ling1 I thin0 it )o"l ,hallenge
her a &it more an help her learn a ne) program1
2
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Positi*e +a,tors !reas +or Impro*ement
I thin0 I ha*e one a goo 2o& maintaining the
Dire,tor3s s,he"le an ma0ing her appointments1
I al)ays ma0e s"re neee repairs are mae /"i,0ly1
I3 li0e to )or0 on sening o"t ,orresponen,e an e5
mails that are error free1 E*en tho"gh I proof5rea
them &efore I sen them# I still seem to ma0e mista0es1
I feel li0e I nee to sho) more attention to etail in my
role as &"iling ,oorinator1
Additional Comments
I )o"l li0e help )ith ,orresponen,e an e5mails &efore I sen them o"t1 I feel em&arrasse o,,asionally )ith
my grammati,al errors1
3
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Positi*e +a,tors !reas +or Impro*ement
St"ent re,ors are a,,"rate an )ell5manage1 6here are times )hen the offi,e is f"ll of st"ents an I
fin myself isorgani7e )hen that happens1 I feel li0e
I ,an3t ,ontrol the flo) of st"ents "ring ,ertain ho"rs1
Additional Comments
It )o"l help to 0no) )hen the pea0 times are1 I ,o"l prepare a plan to hanle the ,ro) &etter1 %an I ma0e a
proposal an ha*e yo" re*ie) it8
Revised 5/5/2008
4
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Positi*e +a,tors !reas +or Impro*ement
(e,a"se of all the )or0 I p"t in )ith managing the
&"get an e*eloping the ne) spreasheet system#
the epartment no) has the a&ility to ma0e
pro2e,tions an ,reate &"get reports )e ha*e ne*er
ha &efore1

Additional Comments
I plan to sign "p for !*an,e E',el training no) that I ha*e mastere &asi, e',el1
5
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Positi*e +a,tors !reas +or Impro*ement
6he +a,"lty Planning Pro,ess has gone pretty
smoothly1
I fin the pro,ess &oring1 I 0no) I3m not as enth"se
)ith this part of my 2o& an I g"ess I3m not as proa,ti*e
as I sho"l &e1
Additional Comments
Is there anything I ,an o to ma0e this responsi&ility more interesting or is this 2"st the )ay it has to &e8
.*erriing
Departmental
9al"es
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Positi*e +a,tors !reas +or Impro*ement
I am )illing to o anything for the epartment1 !t times# the st"ents are har to please ma0ing it
iffi,"lt to ser*e them effe,ti*ely1
Additional Comments
Special Assignments and Rating
Revised 5/5/2008
Spe,ial
!ssignments
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Positi*e +a,tors !reas +or Impro*ement
I am no) ,o5,hairing of the Staff !*isory %o"n,il1 I
thin0 )e ha*e &een a&le to a,,omplish more than )e
imagine )o"l &e possi&le1

Additional Comments

"verall Results & Rating
An employee must receive at least one Notification of Extraordinary Contribution before the first
workday in September in order to be eligible for an overall Extraordinary Contributor! rating
during the same performance cycle" #owever$ receipt of such a notification does not guarantee
an overall rating of Extraordinary Contributor"
An employee must receive at least one %mprovement Needed Notification &orm before the first
workday in September or a 'ritten Notice in order to be eligible for an overall (elow Contributor!
rating during the same performance cycle" An employee who earns an overall rating of (elow
Contributor! must be reviewed again within three months"
%ontri&"tor E'traorinary %ontri&"tor (elo) %ontri&"tor
Signatures
S"per*isor3s %omments:

S"per*isor3s Signat"re:
People Soft
ID#

Date:
S"per*isor3s Name Printe:

Position N"m&er

:e*ie)er3s %omments:

:e*ie)er3s Signat"re: Date:
Revised 5/5/2008
:e*ie)er3s Name Printe:

Position N"m&er

Employee %omments: ;Please ,he,0 the &o' &elo) only if it applies<
I )as not gi*en an opport"nity to pro*ie a self5assessment
I en2oy )or0ing for yo" an in the English Department1 6han0 yo" for helping me &e s",,essf"l in my 2o&1
Employee3s Signat"re: Date: !"g"st 5# 200$
Employee3s Name Printe:
Jane Smith
People Soft ID#
+.:=6E>6 100012345
Revised 5/5/2008