Free 53741.pdf - Indiana

NEW HIRE APPRAISAL FOR OTHER THAN MERIT EMPLOYEES
State Form 53741 (10-08)

This optional form can be used to evaluate employee performance during the first six months of employment.

Name of Employee Class Title/Class Code Name of Supervisor RATING SCALE
· · Meets Expectations: Does Not Meet Expectations:

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

to

Consistently meets the requirements of the job in all aspects Does not meet the minimum standards of performance

COMPETENCIES 1. Results:

Rating Meets Expectations Does Not Meet Expectations Rating Meets Expectations Does Not Meet Expectations Rating Meets Expectations Does Not Meet Expectations Rating Meets Expectations Does Not Meet Expectations Rating Meets Expectations Does Not Meet Expectations Rating Meets Expectations Does Not Meet Expectations

2. Results:

3. Results:

4. Results:

5. Results: 6. Results:

PERFORMANCE REVIEW SUMMARY Overall Rating: Meets Expectations Does Not Meet Expectations - Termination Effective Date: 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.

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)