DEPARTMENT OF EDUCATION

PROVINCE OF ANTIQUE
DISTRICT OF SAN REMIGIO II

PERFORMANCE EVALUATION FORM

Office Assignment:

Name of Intern:

Office Assignment:

Evaluation Period:

Grading Scale:
5 – Outstanding 4 – Very Satisfactory 3 – Satisfactory 2 – Good 1 – Poor

EVALUATION FACTORS RATE

Good working knowledge of job assignment. 5
Organizes and performs work in a timely, professional manner. 5
Performance
Prepares and submits satisfactory/quality output. 5
Willingly accepts feedback related to job assignment. 5
Communicates clearly and intelligently in person and during 5
Communication
telephone contacts.
Performs assigned duties with little or no supervision, even under 5
Initiative pressure.
Strives to meet deadlines. 5
Reports to work on time. 5
Dedication
Uses time constructively. 5
Willingly accepts work assignments. 5
Cooperation
Willingly accepts changes in assignments not directly related to job. 5
Works well with fellow employees and maintains good working 5
Teamwork
relationship with peers and superiors.
Accepts constructive criticism without unfavorable responses. 5
Demonstrates a pleasant, courteous personality when dealing with 5
Character
customers and fellow employees
Shows respectfulness to superiors 5
TOTAL 75
AVERAGE (total / 15) 5

Note: Average Rating of 3 (Satisfactory) - 5 (Outstanding) shall be the basis for Contract Renewal.

Comments and Recommendations: The intern has an initiative to work on things assigned
to her and does it outstandingly.

X Recommended for Internship Renewal

Recommended for Internship Termination

Immediate Supervisor: Head of Office:

School Principal I ______________________

Date: May 27, 2021 Date: _____________________

DOLE I-Text Nos.:

DOLE Regional Office 09173276515, 09178351588 Capiz Field Office 09173275220
09173276818 & 09989795369 Iloilo Field Office 09173276719
Aklan Field Office 09173273132 Guimaras Field Office 09176582101
Boracay Satellite Office 09177144993 Negros Occidental Field Office 09173275919
Antique Field Office 09173275313