Free 51637.pdf - Indiana

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