‫ﻓﻮرم ارزﻳﺎﺑﻲ ﻣﺎﻣﻮر ﺧﺪﻣﺎت ﻣﻠﻜﻲ‬

‫‪........................................................................................................................................‬‬ ‫ﻛﻮد ﺗﺸﻜﻴﻼﺗﻲ ﺑﺴﺖ‪:‬‬ ‫ـــــــــــ‬ ‫ـــــــــــ ‪ /‬ـــــــــــ ‪/‬‬ ‫اﻟﻲ‬ ‫از ﺗﺎرﻳﺦ ـــــــــــ‪/‬ـــــــــــ ‪/‬‬
‫ـــــــــــ‬ ‫ﻣﻴﻌﺎد ارزﻳﺎﺑﻲ اﺟﺮاآت‪:‬‬
‫ﺑﺨﺶ اول‪ :‬ﻣﻌﻠﻮﻣﺎت ﻋﻤﻮﻣﻲ‬
‫اﻳﻦ ﺑﺨﺶ ﺷﺎﻣﻞ ﻣﻌﻠﻮﻣﺎت ﻋﻤﻮﻣﻲ ﻣﺎﻣﻮر ﺑﻮده‪ ،‬ﺗﻮﺳﻂ ارزﻳﺎﺑﻲ ﺷﻮﻧﺪه و ﻳﺎ رﻳﺎﺳﺖ ﻣﻨﺎﺑﻊ ﺑﺸﺮي ﺑﺎ درﻧﻈﺮداﺷﺖ دﻓﺘﺮ ﺳﻮاﻧﺢ ﻣﺎﻣﻮر ﺑﺼﻮرت دﻗﻴﻖ و ﻛﺎﻣﻞ ﺧﺎﻧﻪ ﭘﺮي ﻣﻲ ﮔﺮدد‪.‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫وزارت‪ /‬اداره‪:‬‬

‫‪ -3‬درﺟﻪ ﺗﺤﺼﻴﻞ‪:‬‬ ‫‪ -2‬اﺳﻢ ﭘﺪر‪:‬‬ ‫‪ -1‬اﺳﻢ و ﺗﺨﻠﺺ‪:‬‬

‫‪ -6‬ﻋﻨﻮان وﻇﻴﻔﻪ‪:‬‬ ‫‪ -5‬ﺗﺎرﻳﺦ ﺗﻘﺮر در وﻇﻴﻔﻪ ﻓﻌﻠﻲ‪:‬‬ ‫‪ -4‬رﺷﺘﻪ ﺗﺤﺼﻴﻞ‪ :‬و ﺗﺠﺎرت‬
‫اﻗﺘﻀﺎﺋﻲ‬ ‫ﺳﺎﻻﻧﻪ‬ ‫آزﻣﺎﻳﺸﻲ‬ ‫‪ -9‬ﻧﻮع ارزﻳﺎﺑﻲ‪:‬‬ ‫ﻣﺤﻠﻲ‬ ‫ﻣﺮﻛﺰي‬ ‫‪ -8‬ﻣﺤﻞ وﻇﻴﻔﻪ‪:‬‬ ‫(‬ ‫( ﻗﺪم‪) :‬‬ ‫‪ -7‬ﺑﺴﺖ‪) :‬‬

‫ﺑﺨﺶ دوم‪ :‬اﻫﺪاف اﺳﺎﺳﻲ ﭘﻼن ﺳﺎﻻﻧﻪ‬

‫اﻳﻦ ﺑﺨﺶ ﺷﺎﻣﻞ اﻫﺪاف اﺳﺎﺳﻲ ﭘﻼن ﻛﺎر ﻣﻨﻈﻮر ﺷﺪه ﻣﺎﻣﻮر اﺳﺖ ﻛﻪ ﺑﺮاي ﻣﺎﻣﻮرﻳﻦ ردﻳﻒ )ب( )‪ (8‬ﻣﻮرد و ﺑﺮاي ﻣﺎﻣﻮرﻳﻦ ردﻳﻒ )ج‪ ،‬د( )‪ (5‬ﻣﻮرد ﻗﺎﺑﻞ ارزﻳﺎﺑﻲ ﻣﻲ ﺑﺎﺷﺪ‪ .‬ﻫﺮ ﻫﺪف ﺑﺮاي ﻣﺎﻣﻮرﻳﻦ ردﻳﻒ )ب( ﺣﺪ اﻛﺜﺮ داراي )‪ (7,5‬ﻧﻤﺮه‬
‫ﺑﻮده و ﺑﺮاي ﻣﺎﻣﻮرﻳﻦ ردﻳﻒ ﻫﺎي )ج‪ ،‬د( ﺣﺪ اﻛﺜﺮ داراي )‪ (12‬ﻧﻤﺮه ﺑﻮده و ﻣﺠﻤﻮﻋﺎً )‪ (60‬ﻧﻤﺮه ﻣﻴﺸﻮد‪.‬‬
‫دﻻﻳﻞ آﻣﺮ ﻣﺴﺘﻘﻴﻢ در ﻣﻮرد ﻧﻤﺮه دﻫﻲ ﺧﻮﻳﺶ‬ ‫ﻧﻤﺮه آﻣﺮ ﻣﺴﺘﻘﻴﻢ‬ ‫ﻧﻤﺮه ﻣﺎﻣﻮر‬ ‫اﻫﺪاف اﺳﺎﺳﻲ ﭘﻼن ﻛﺎري‬ ‫ﺷﻤﺎره‬
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‫‪5‬‬

‫‪0.0‬‬ ‫ﻣﺠﻤﻮع ﻧﻤﺮات‬

‫ﺣﻜﻮﻣﺘﺪاري ﺧﻮب و ﻣﺒﺎرزه ﻋﻠﻴﻪ ﻓﺴﺎد اداري ﺻﺮف ﺑﺮاي ﻣﺎﻣﻮرﻳﻦ ردﻳﻒ )ب( واﺣﺪ ﻫﺎي ﻣﺮﻛﺰي‬
‫ﺗﺤﻘﻖ اﻫﺪاف و ﭘﻼن ﻫﺎي اﺳﺘﺮاﺗﻴﮋي ﻣﻠﻲ و ﻣﺪﻳﺮﻳﺖ ﻣﺆﺛﺮ و ﻣﺜﻤﺮ ﺑﺮﻧﺎﻣﻪ ﻫﺎ و ﭘﺮوژه ﻫﺎي اﻧﻜﺸﺎﻓﻲ ﻣﺮﺑﻮﻃﻪ‬ ‫‪6‬‬
‫اراﻳﻪ ﻣﻌﻠﻮﻣﺎت ﺑﻪ ﻣﻮﻗﻊ ﺑﻪ ادارات دوﻟﺘﻲ‪ ،‬ﺟﺎﻣﻌﻪ ﻣﺪﻧﻲ‪ ،‬رﺳﺎﻧﻪ ﻫﺎ و ﺷﻬﺮوﻧﺪان ﺑﺎ در ﻧﻈﺮداﺷﺖ ﻗﺎﻧﻮن دﺳﺘﺮﺳﻲ ﺑﻪ اﻃﻼﻋﺎت و ﭘﺎﻟﻴﺴﻲ اداره ﻣﺮﺑﻮﻃﻪ‬ ‫‪7‬‬
‫رﻋﺎﻳﺖ و ﺣﺼﻮل اﻃﻤﻴﻨﺎن از ﺗﻄﺒﻴﻖ ﻗﺎﻧﻮن اﺟﺮاآت اداري و ﻗﺎﻧﻮن ﻣﻨﻊ آزارواذﻳﺖ زﻧﺎن و اﻃﻔﺎل در ﺳﺎﺣﻪ ﻛﺎري ﻣﺮﺑﻮﻃﻪ‬ ‫‪8‬‬

‫‪0.0‬‬ ‫ﻣﺠﻤﻮع ﻧﻤﺮات‬

‫‪0.0‬‬ ‫ﻣﺠﻤﻮع ﻋﻤﻮﻣﻲ ﻧﻤﺮات اﻫﺪاف اﺳﺎﺳﻲ ﭘﻼن ﻛﺎري و ﺣﻜﻮﻣﺘﺪاري ﺧﻮب و ﻣﺒﺎرزه ﻋﻠﻴﻪ ﻓﺴﺎد اداري‬

‫)‪(1‬‬
 ‫ﺑﺨﺶ ﺳﻮم‪ :‬ﺷﺎﺧﺺ ﻫﺎي ارزﻳﺎﺑﻲ ﺷﺎﻳﺴﺘﮕﻲ ﻫﺎ ﺑﺮاي ﻣﺎﻣﻮرﻳﻦ ردﻳﻒ )ب(‪) ،‬ج( و )د( واﺣﺪ ﻫﺎي ﻣﺮﻛﺰي‬
‫اﻳﻦ ﺑﺨﺶ ﺷﺎﻣﻞ )‪ (6‬ﺷﺎﺧﺺ ﺑﻮده و ﻫﺮ ﺷﺎﺧﺺ ﺣﺪاﻛﺜﺮ داراي )‪ (4‬ﻧﻤﺮه ﻛﻪ ﻣﺠﻤﻮﻋﺎً )‪ (24‬ﻧﻤﺮه ﻣﻴﺸﻮد‪.‬‬
‫دﻻﻳﻞ آﻣﺮ ﻣﺴﺘﻘﻴﻢ در ﻣﻮرد ﻧﻤﺮه ﺧﻮﻳﺶ‬ ‫ﻧﻤﺮه آﻣﺮ ﻣﺴﺘﻘﻴﻢ‬ ‫ﻧﻤﺮه ﻣﺎﻣﻮر‬ ‫ﺷﺎﺧﺺ ﻫﺎي ارزﻳﺎﺑﻲ ﺷﺎﻳﺴﺘﮕﻲ ﻫﺎ‬ ‫ردﻳﻒ‬ ‫ﺷﻤﺎره‬

‫رﻫﺒﺮي )اﻳﺠﺎد اﻧﮕﻴﺰه‪ ،‬ﻗﺮار دادن ﻣﺎﻣﻮرﻳﻦ در ﻣﺴﻴﺮ رﺳﻴﺪن ﺑﻪ اﻫﺪاف‪ ،‬ﺗﻐﻴﻴﺮ و ﺗﺤﺮك و ﺗﺎﻣﻴﻦ ارﺗﺒﺎﻃﺎت ﻣﺆﺛﺮ(‬ ‫ب‬
‫‪1‬‬
‫ﻫﻤﻜﺎري‪ ،‬ﻫﻤﺎﻫﻨﮕﻲ و ﻣﺸﺎرﻛﺖ )داﺷﺘﻦ روﺣﻴﻪ ﻛﺎر ﮔﺮوﭘﻲ‪ ،‬ﺑﻪ اﺷﺘﺮاك ﮔﺬاري اﻃﻼﻋﺎت و ﻣﻨﺎﺑﻊ‪ ،‬ﭘﻴﺸﺒﺮد ﻛﺎر ﺑﺼﻮرت ﻣﺸﺘﺮك(‬ ‫ج‪ ،‬د‬

‫ﭘﻼﻧﮕﺬاري و ﺗﺼﻤﻴﻢ ﮔﻴﺮي )ﻣﺴﺌﻠﻪ ﻳﺎﺑﻲ‪ ،‬ﺗﻌﻴﻴﻦ اﻫﺪاف و ﻣﻘﺎﺻﺪ‪ ،‬اوﻟﻮﻳﺖ ﺑﻨﺪي ﻓﻌﺎﻟﻴﺖ ﻫﺎ و ﭘﻴﺶ ﺑﻴﻨﻲ ﻣﻨﺎﺑﻊ ﻣﻮرد ﻧﻴﺎز(‬ ‫ب‪ ،‬ج‪ ،‬د‬ ‫‪2‬‬

‫ﺧﻼﻗﻴﺖ و ﻧﻮآوري و داﺷﺘﻦ اﻧﮕﻴﺰه ﺑﺮاي ﻛﺎر ﺑﻬﺘﺮ )داﺷﺘﻦ ﻃﺮح ﻫﺎي ﺟﺪﻳﺪ و اراﺋﻪ آن ﻛﻪ ﻣﻨﺠﺮ ﺑﻪ ﺗﻐﻴﻴﺮ روش ﻛـﺎر‪ ،‬ﻛـﺎﻫﺶ‬
‫ب‪ ،‬ج‪ ،‬د‬ ‫‪3‬‬
‫زﻣﺎن و ﻫﺰﻳﻨﺔ اﻧﺠﺎم ﻛﺎر ﻫﺎ و ﺑﻬﺒﻮد ﻧﺘﺎﻳﺞ ﮔﺮدد(‬

‫ﺗﻮﺟﻪ ﺑﻪ ﺧﺪﻣﺖ رﺳﺎﻧﻲ )ﺗﻮاﻧﺎﻳﻲ ﺟﺴﺘﺠﻮي ﻓﻌﺎﻻﻧﻪ ﺑﺮاي ﻳﺎﻓﺘﻦ روش ﻫﺎﻳﻲ ﺑﻪ ﻣﻨﻈﻮر ﻛﻤﻚ ﺑﻪ ﻣﺮدم(‬ ‫ب‪ ،‬ج‪ ،‬د‬ ‫‪4‬‬

‫ﻧﻈﺎرت و ارزﻳﺎﺑﻲ )ﺗﻮاﻧﺎﻳﻲ ﻧﻈﺎرت و ارزﻳﺎﺑﻲ اﺟﺮاآت ﻣﺎﻣﻮرﻳﻦ ﺗﺤﺖ اﺛﺮ‪ ،‬ﻣﺮور ﺑﺮﻧﺎﻣﻪ ﻫﺎ و ﻓﻌﺎﻟﻴﺖ ﻫﺎي ﻛﺎري ﺧﻮد(‬ ‫ب‪ ،‬ج‪ ،‬د‬ ‫‪5‬‬

‫ﺗﻮﺳﻌﻪ و ﺗﻮاﻧﻤﻨﺪ ﺳﺎزي )راﻫﻨﻤﺎﻳﻲ زﻳﺮدﺳﺘﺎن‪ /‬ﻫﻤﻜﺎران و ﺑﻠﻨﺪ ﺑﺮدن ﺳﻄﺢ ﻇﺮﻓﻴﺖ و ﻋﻤﻠﻜﺮد ﺧﻮد(‬ ‫ب‪ ،‬ج‪ ،‬د‬ ‫‪6‬‬

‫‪0‬‬ ‫ﻣﺠﻤﻮع ﻧﻤﺮات‬

‫ﺑﺨﺶ ﭼﻬﺎرم‪ :‬ﻃﺮز ﺳﻠﻮك‬

‫اﻳﻦ ﺑﺨﺶ ﺷﺎﻣﻞ )‪ (4‬ﻣﻮرد اﺳﺖ‪ .‬ﻫﺮ ﻣﻮرد ﺣﺪاﻛﺜﺮ داراي )‪ (4‬ﻧﻤﺮه ﻛﻪ ﻣﺠﻤﻮﻋﺎً )‪ (16‬ﻧﻤﺮه ﻣﻴﺸﻮد‪.‬‬
‫دﻻﻳﻞ آﻣﺮ ﻣﺴﺘﻘﻴﻢ در ﻣﻮرد ﻧﻤﺮه ﺧﻮﻳﺶ‬ ‫ﻧﻤﺮه آﻣﺮ ﻣﺴﺘﻘﻴﻢ‬ ‫ﻧﻤﺮه ﻣﺎﻣﻮر‬ ‫ﻃﺮز ﺳﻠﻮك‬ ‫ﺷﻤﺎره‬

‫ﺣﺴﻦ ﺳﻠﻮك ﺑﺎ ﻫﻤﻜﺎران و ﻣﺮاﺟﻌﻴﻦ‬ ‫‪1‬‬

‫اﺟﺮاآت ﻣﺴﻠﻜﻲ و ﭘﺎﺑﻨﺪي ﺑﻪ وﻇﻴﻔﻪ‬ ‫‪2‬‬

‫ﺷﻔﺎﻓﻴﺖ و ﺣﺴﺎﺑﺪﻫﻲ‬ ‫‪3‬‬

‫ﺗﺤﻜﻴﻢ ﻗﺎﻧﻮﻧﻴﺖ‬ ‫‪4‬‬

‫‪0‬‬ ‫ﻣﺠﻤﻮع ﻧﻤﺮات‬

‫)‪(2‬‬
 ‫ﺑﺨﺶ ﭘﻨﺠﻢ‪ :‬ﻧﺘﻴﺠﻪ ﻧﻬﺎﻳﻲ‬

‫‪.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﭘﻴﺸﻨﻬﺎدات آﻣﺮ ﻣﺴﺘﻘﻴﻢ ﺑﻪ ﻣﻨﻈﻮر ﺑﻬﺒﻮد اﺟﺮاآت و ﻣﻌﺮﻓﻲ ﻣﺎﻣﻮر ﺑﻪ ﺑﺮﻧﺎﻣﻪ ﻫﺎي آﻣﻮزﺷﻲ‪:‬‬
‫‪...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﻣﺠﻤﻮع ﻧﻤﺮات ﺑﺨﺶ اﻫﺪاف اﺳﺎﺳﻲ ﭘﻼن ﻛﺎري و ﺣﻜﻮﻣﺘﺪاري ﺧﻮب و ﻣﺒﺎرزه ﻋﻠﻴﻪ ﻓﺴﺎد اداري‬
‫‪................................................................................................................................................‬‬ ‫اﺳﻢ آﻣﺮ ﻣﺴﺘﻘﻴﻢ‪ ..................................................................................................................... :‬ﻋﻨﻮان وﻇﻴﻔﻪ‪:‬‬
‫ﻣﺠﻤﻮع ﻧﻤﺮات ﺑﺨﺶ ارزﻳﺎﺑﻲ ﺷﺎﻳﺴﺘﮕﻲ ﻫﺎ‬

‫ﻣﺠﻤﻮع ﻧﻤﺮات ﺑﺨﺶ ﻃﺮز ﺳﻠﻮك‬ ‫اﻣﻀﺎء‪ ................................................................................................................................................................................................ :‬ﺗﺎرﻳﺦ‪____/____/____ :‬‬

‫ﻣﺠﻤﻮع ﻧﻤﺮات ﻋﻤﻮﻣﻲ آﻣﺮ ﻣﺴﺘﻘﻴﻢ‬

‫رد‬ ‫ﺗﺎﺋﻴﺪ‬ ‫اراﻳﻪ ﻧﻈﺮات و دﻻﻳﻞ آﻣﺮ ﻣﺎﻓﻮق‪:‬‬

‫‪....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫(‬ ‫ﻣﺠﻤﻮع ﻧﻤﺮه ﻧﻬﺎﻳﻲ آﻣﺮ ﻣﺎﻓﻮق‪) :‬‬ ‫ﺗﺎرﻳﺦ‪____/____/____ :‬‬ ‫‪.........................................................................................................................‬‬ ‫اﻣﻀﺎء‪:‬‬ ‫‪........................................................................................................................................................‬‬ ‫ﻋﻨﻮان وﻇﻴﻔﻪ‪:‬‬ ‫‪......................................................................................................................‬‬ ‫اﺳﻢ‪:‬‬

‫ﻋﺪم‬ ‫ﻗﻨﺎﻋﺖ‬ ‫ﺗﺎرﻳﺦ‪____/____/____ :‬‬ ‫‪..........................................................................................................................................................‬‬ ‫اﻣﻀﺎء‪:‬‬ ‫‪.........................................................................................................................................................‬‬ ‫اﺳﻢ‪:‬‬ ‫ﻧﻈﺮ ﻣﺎﻣﻮر در ﻣﻮرد ﻧﺘﻴﺠﻪ ارزﻳﺎﺑﻲ اﺟﺮاآت‪:‬‬
‫ﻗﻨﺎﻋﺖ‬

‫‪ 55‬ﻧﻤﺮه و ﭘﺎﺋﻴﻨﺘﺮ‪ ،‬اﻧﻔﺼﺎل از ﺑﺴﺖ‬ ‫‪ 56‬اﻟﻲ ‪ 84‬ﻧﻤﺮه‪ ،‬دوام وﻇﻴﻔﻪ در ﻗﺪم ﻓﻌﻠﻲ‬ ‫‪ 85‬اﻟﻲ ‪ 100‬ﻧﻤﺮه‪ ،‬ارﺗﻘﺎء ﺑﻪ ﻗﺪم ﺑﺎﻻﺗﺮ‬ ‫ﻧﺘﻴﺠﻪ ﻧﻬﺎﻳﻲ ارزﻳﺎﺑﻲ اﺟﺮاآت‪:‬‬

‫ﻧﻈﺮ ﻛﺎرﺷﻨﺎس ﻧﻈﺎرت از ﻣﺪﻳﺮﻳﺖ اﺟﺮاآت‪ /‬رﺋﻴﺲ‪ /‬آﻣﺮ‪ /‬ﻛﺎرﺷﻨﺎس ﻧﻈﺎرت از ارزﻳﺎﺑﻲ اﺟﺮاآت ﻛﻤﻴﺴﻴﻮن ﻣﺴﺘﻘﻞ اﺻﻼﺣﺎت اداري و ﺧﺪﻣﺎت ﻣﻠﻜﻲ‪ /‬ﻧﻈﺎرت ﻛﻨﻨﺪه ارزﻳﺎﺑﻲ اﺟﺮاآت وزارت ﻫﺎ و ادارات دوﻟﺘﻲ‪:‬‬

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‫ﺗﺎرﻳﺦ‪____/____/____ :‬‬ ‫‪...........................................................................................................................................................‬‬ ‫اﻣﻀﺎء‪:‬‬ ‫‪.............................................................................................................................................................................‬‬ ‫ﻋﻨﻮان وﻇﻴﻔﻪ‪:‬‬ ‫‪...............................................................................................................................................................................................‬‬ ‫اﺳﻢ‪:‬‬

‫)‪(3‬‬