Form A
INTERNS EVALUATION FORM
A. BIODATA
(To be completed by Intern)
NAME: ____________________________________________________
DATE OF BIRTH: ____________________________________________
MARITAL STATUS: ___________________________________________
LOCAL GOVERNMENT AREA: __________________________________
STATE OF ORIGIN: ___________________________________________
DATE OF ENGAGEMENT AS INTERN: ____________________________
PLACE OF RESIDENCE: ________________________________________
PHONE NO: ________________________________________________
EMAIL: ____________________________________________________
B. QUALIFICATIONS/AWARDING INSTITUTIONS
(From highest qualification / Attach Photocopies of certificates)
S/N Qualification(s) Institution(s) Date of award of
Degree/Cert
1
C. PROFESSIONAL CERTIFICATES:
(Attach Photocopies of certificates)
S/ Qualification(s) Professional Body Date of
N Induction
D. TRAINING PROGRAM ATTENDED
(Attach Photocopies of certificates)
S/ Training Title Certificate Organized by Date
N obtained
E. ONGOING CAPACITY DEVELOPMENT/INSTITUTION:
(Attach Photocopies of Admission)
S/N Certificate in view Organization/ Date of Date of
Institution(s) commencement completion
2
F. DUTIES PERFORMED WHEN ON INTERNSHIP:
(To be completed by Intern)
S/N DUTIES:
G. TASK ACCOMPLISHED BY THE INTERN (To be filled by Intern)
S/N TASK ACCOMPLISHED
SUPERVISOR’S NAME: ________________________________________
DESIGNATION: ______________________________________________
Note: You may wish to use extra sheet where provided fields cannot
accommodate your information please.
3
Form B
INTERN EVALUTION FORM
JOB PERFORMANCE REVIEW
(B) to be completed by supervisor: ED/Directors/HOD/HOU/ZC
NAME OF INTERN: ___________________________________________________
SERVED IN: _________________________________________________________
(Directorate/Department/Unit/Zone)
PERIOD OF INTERNSHIP IN THE DIRECTORATE/DEPARTMENT/UNIT/ZONE:
From: ______________________________To: ______________________________________
1. ASSIGNED RESPONSIBILITIES: (To be filled by supervisor)
S/N RESPONSIBILITIES
4
2. PERFORMANCE ASSESSMENT
S/N Criteria 5 4 3 2 1 N/A OR
NEW
1 Knowledge of job.
2 Initiatives.
3 Dependability.
4 Accountability and resilience to sees tasks through to completion
5 Efficiency in job delivery.
6 Communicates skills: Communicate effectively with supervisor, peer and
stakeholders
7 Ability to work without supervision.
8 Team work: Ability to work cooperatively with colleagues or as a team.
9 Willingness to take additional responsibilities.
10 Reliability (attendance, punctuality, meeting deadlines).
11 Problem solving, decision making and analytical skills
12 Represents the Agency in a positive manner when interacting with stakeholders.
13 Personal development of professional skills.
14 Follows through with tasks and responsibilities in an appropriate and timely
manner.
15 Responsiveness
16 Cooperation
17 Compliance to rules and regulation in the office.
18 Management of working materials
19 Attendance at work
20 Contributions to job improvement
GUIDE:
“5” EXCEPTIONAL: Performance is consistently superior and significantly exceeds position requirements.
“4” HIGHLY EFFECTIVE: Performance frequently exceeds position requirements.
“3” PROFICIENT: Performance consistently meets position requirements.
“2” INCONSISTENT: Performance meets some, but not all position requirements.
“1” UNSATISFACTORY: Performance consistently fails to meet minimum position requirements. Personnel lacks skills required or
fails to utilize necessary skills.
“N/A OR NEW”: Employee has not been in position long enough to have demonstrated the essential elements of the position
and will be reviewed at a later agreed upon date.
SUPERVISOR’S NAME: _______________________________________________
DESIGNATION: _____________________________________________________
