State Form 51637 (3-04)
INDIANA CONSERVATION STAFF PERFORMANCE APPRAISAL REPORT
Name of employee, Last, First, MI: Name of state agency: Social Security number Org code Review period (month / year)
Name:
IDNR, Law Enforcement
Class title and class code of employee:
Type of Evaluation
Annual
3-Month
6-Month
Follow-up
Other
Instructions For each applicable responsibility, assign the most suitable performance rating. Substantiate ratings of `Unsatisfactory" on the Comments Report
Overall Performance
Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory
Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory
Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
Overall Performance
Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory
Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory
Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
Overall Performance
Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory
Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory
Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
Overall Job Knowledge and Skill Dependability Motivation Employee Initial
General Responsibilities Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Superior Initial
Not applicable Not applicable Not applicable
Evaluator Initial
Indiana Conservation Staff Performance Appraisal Report - Page 2
General Responsibilities Continued Personal Appearance Satisfactory Unsatisfactory Equipment Appearance / Maintenance Satisfactory Unsatisfactory Composure / Stability Satisfactory Unsatisfactory Radio Communications Satisfactory Unsatisfactory Service & Public Relations Satisfactory Unsatisfactory Inter-Departmental / Agency Relations Satisfactory Unsatisfactory Follows Proper Procedures / Judgment Satisfactory Unsatisfactory Overall General Responsibility Satisfactory Unsatisfactory Performance Total Overall Job Performance
Signature of Employee
Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not applicable
Satisfactory
Date signed
Unsatisfactory
Date signed
Signature of Evaluator
I hereby certify that I have had an opportunity to review this report and Understand that I am to receive a copy. I am aware that my signature does not Necessarily mean that I agree with the rating.
I hereby certify that this rating report constitutes my best judgment of the Service performed by this employee for the review period covered.
Signature of Superior
Signature of Appointing Authority