Free 53740.pdf - Indiana

MERIT WORKING TEST APPRAISAL
State Form 53740 (10-08)

This form will be used to evaluate employee performance at the end of the working test period for MERIT EMPLOYEES only. IC 4-15-2-21

Name of Employee Class Title/Class Code Name of Supervisor

Employee ID Number/Last 4 Digits of SSN Division Review Period From

to

RATING SCALE
· · · Meets Expectations: Needs Improvement: Does Not Meet Expectations: Consistently meets the requirements of the job in all aspects Sometimes acceptable, but not consistent; needs improvement to meet expectations Does not meet the minimum standards of performance

COMPETENCIES 1. Results: Rating Meets Expectations Needs Improvement Does Not Meet Expectations Rating Meets Expectations Needs Improvement Does Not Meet Expectations Rating Meets Expectations Needs Improvement Does Not Meet Expectations Rating Meets Expectations Needs Improvement Does Not Meet Expectations Rating Meets Expectations Needs Improvement Does Not Meet Expectations Rating Meets Expectations Needs Improvement Does Not Meets Expectations

2. Results:

3. Results:

4. Results:

5. Results:

6. Results:

DEVELOPMENTAL NEEDS (If requesting an extension) Competency to Develop 1. 2. 3. Competency to Develop 1. 2. 3. Competency to Develop 1. 2. 3. PERFORMANCE REVIEW SUMMARY
Overall Rating: Meets Expectations Needs Improvement Successfully Completed. Permanent Status Granted. Effective Date (month, day, year): Request Extension for six months. Effective Date (month, day, year): Date (month, day, year): Working Test Period Terminated. Effective Date (month, day, year):

Developmental Activities

Developmental Activities

Developmental Activities

State Personnel Director Approval: Does not Meet Expectations

ADDITIONAL COMMENTS

CERTIFICATION
I hereby certify that this report constitutes an accurate evaluation using my best judgment of the service performed by this employee for the review period covered.

Signature of Evaluator

Signature of Reviewer

Signature of Appointing Authority

Date (month, day, year)

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 I agree with the rating.

Signature of Employee

Date (month, day, year)