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Section I:\nEmployee InformationCheck\nOne☐ Full-Time\n☐ Part-TimeCheck\nOne☐ Probationary Review\n☐ Annual Review
Employee\nNameDepartmentProbationary\n90-180 Day\nReview☐ 90 ☐ 180\n☐ Other: ________
Employee\nID #Job TitleEvaluation\nPeriod
Section II: Employee Self-Assessment (To be completed by employee before meeting with supervisor)
Please complete the Employee Self-Assessment to evaluate your performance, accomplishments, and goals for the specified period by filling out the sections below.
1. What were your major achievements during the evaluation period? (Ex. Created a new process, spearheaded a training course, participated in a community service project, etc.)
2. What topics would you like to discuss during your evaluation?
3. How do you believe you performed in your role during this evaluation period? Are there areas where you believe you could improve? If so, how do you plan to address them?
4. Did you meet your professional development goals for this evaluation period?
5. What suggestions do you have for improving your role, team, or department?
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"Check\nOne", "links": [], "cell_header_index": 4, "rowspan": 1, "colspan": 1, "column_header": true, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 500.24, 682.128, 592.32, 725.52 ], "text": "☐ Probationary Review ☐ Annual Review", "html_text": "☐ Probationary Review\n☐ Annual Review", "links": [], "cell_header_index": 5, "rowspan": 1, "colspan": 1, "column_header": true, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 1, "location": [ 39.84, 638.736, 592.32, 682.128 ], "cells": [ { "location": [ 39.84, 638.736, 131.92, 682.128 ], "text": "Employee Name", "html_text": "Employee\nName", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 131.92, 638.736, 224, 682.128 ], "text": "", "html_text": "", "links": [], "cell_header_index": 1, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 224, 638.736, 316.08, 682.128 ], "text": "Department", "html_text": "Department", "links": [], "cell_header_index": 2, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 316.08, 638.736, 408.16, 682.128 ], "text": "", "html_text": "", "links": [], "cell_header_index": 3, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 408.16, 638.736, 500.24, 682.128 ], "text": "Probationary 90-180 Day Review", "html_text": "Probationary\n90-180 Day\nReview", "links": [], "cell_header_index": 4, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 500.24, 638.736, 592.32, 682.128 ], "text": "☐ 90 ☐ 180 ☐ Other: ________", "html_text": "☐ 90 ☐ 180\n☐ Other: ________", "links": [], "cell_header_index": 5, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 2, "location": [ 39.84, 595.344, 592.32, 638.736 ], "cells": [ { "location": [ 39.84, 595.344, 131.92, 638.736 ], "text": "Employee ID #", "html_text": "Employee\nID #", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 131.92, 595.344, 224, 638.736 ], "text": "", "html_text": "", "links": [], "cell_header_index": 1, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 224, 595.344, 316.08, 638.736 ], "text": "Job Title", "html_text": "Job Title", "links": [], "cell_header_index": 2, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 316.08, 595.344, 408.16, 638.736 ], "text": "", "html_text": "", "links": [], "cell_header_index": 3, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 408.16, 595.344, 500.24, 638.736 ], "text": "Evaluation Period", "html_text": "Evaluation\nPeriod", "links": [], "cell_header_index": 4, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 500.24, 595.344, 592.32, 638.736 ], "text": "", "html_text": "", "links": [], "cell_header_index": 5, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 3, "location": [ 39.84, 551.952, 592.32, 595.344 ], "cells": [ { "location": [ 39.84, 551.952, 592.32, 595.344 ], "text": "Section II: Employee Self-Assessment (To be completed by employee before meeting with supervisor)", "html_text": "Section II: Employee Self-Assessment (To be completed by employee before meeting with supervisor)", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 4, "location": [ 39.84, 508.56, 592.32, 551.952 ], "cells": [ { "location": [ 39.84, 508.56, 592.32, 551.952 ], "text": "Please complete the Employee Self-Assessment to evaluate your performance, accomplishments, and goals for the specified period by filling out the sections below.", "html_text": "Please complete the Employee Self-Assessment to evaluate your performance, accomplishments, and goals for the specified period by filling out the sections below.", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 5, "location": [ 39.84, 465.168, 592.32, 508.56 ], "cells": [ { "location": [ 39.84, 465.168, 592.32, 508.56 ], "text": "1. What were your major achievements during the evaluation period? (Ex. Created a new process, spearheaded a training course, participated in a community service project, etc.)", "html_text": "1. What were your major achievements during the evaluation period? (Ex. Created a new process, spearheaded a training course, participated in a community service project, etc.)", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 6, "location": [ 39.84, 421.776, 592.32, 465.168 ], "cells": [ { "location": [ 39.84, 421.776, 592.32, 465.168 ], "text": "", "html_text": "", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 7, "location": [ 39.84, 378.384, 592.32, 421.776 ], "cells": [ { "location": [ 39.84, 378.384, 592.32, 421.776 ], "text": "2. What topics would you like to discuss during your evaluation?", "html_text": "2. What topics would you like to discuss during your evaluation?", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 8, "location": [ 39.84, 334.992, 592.32, 378.384 ], "cells": [ { "location": [ 39.84, 334.992, 592.32, 378.384 ], "text": "", "html_text": "", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 9, "location": [ 39.84, 291.6, 592.32, 334.992 ], "cells": [ { "location": [ 39.84, 291.6, 592.32, 334.992 ], "text": "3. How do you believe you performed in your role during this evaluation period? Are there areas where you believe you could improve? If so, how do you plan to address them?", "html_text": "3. How do you believe you performed in your role during this evaluation period? Are there areas where you believe you could improve? If so, how do you plan to address them?", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 10, "location": [ 39.84, 248.208, 592.32, 291.6 ], "cells": [ { "location": [ 39.84, 248.208, 592.32, 291.6 ], "text": "", "html_text": "", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 11, "location": [ 39.84, 204.816, 592.32, 248.208 ], "cells": [ { "location": [ 39.84, 204.816, 592.32, 248.208 ], "text": "4. Did you meet your professional development goals for this evaluation period?", "html_text": "4. Did you meet your professional development goals for this evaluation period?", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 12, "location": [ 39.84, 161.424, 592.32, 204.816 ], "cells": [ { "location": [ 39.84, 161.424, 592.32, 204.816 ], "text": "", "html_text": "", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 13, "location": [ 39.84, 118.032, 592.32, 161.424 ], "cells": [ { "location": [ 39.84, 118.032, 592.32, 161.424 ], "text": "5. What suggestions do you have for improving your role, team, or department?", "html_text": "5. What suggestions do you have for improving your role, team, or department?", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 14, "location": [ 39.84, 74.64, 592.32, 118.032 ], "cells": [ { "location": [ 39.84, 74.64, 592.32, 118.032 ], "text": "", "html_text": "", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 6, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" } ], "n_rows": 15, "n_cols": 6, "ref": "#/tables/0", "reading_order": 1 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 293.04, "t": 717.72, "r": 302.52, "b": 709.2 }, "text": "Full-Time", "field_kind": "checkbox", "label": "Full-Time", "pdf_field_name": "FullTime", "pdf_field_type": "CheckBox", "reading_order": 2 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 468.24, "t": 716.88, "r": 479.28, "b": 709.56 }, "text": "Probationary Review", "field_kind": "checkbox", "label": "Probationary Review", "pdf_field_name": "Probationary Review", "pdf_field_type": "CheckBox", "reading_order": 3 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 293.04, "t": 703.08, "r": 302.52, "b": 694.56 }, "text": "Part-Time", "field_kind": "checkbox", "label": "Part-Time", "pdf_field_name": "PartTime", "pdf_field_type": "CheckBox", "reading_order": 4 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 468.24, "t": 702.6, "r": 479.28, "b": 695.28 }, "text": "Annual Review", "field_kind": "checkbox", "label": "Annual Review", "pdf_field_name": "Annual Review", "pdf_field_type": "CheckBox", "reading_order": 5 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 287.16, "t": 687.48, "r": 395.64, "b": 657.6 }, "text": "Full-Time Part-Time_Department", "field_kind": "text", "label": "Full-Time Part-Time_Department", "pdf_field_name": "FullTime PartTimeDepartment", "pdf_field_type": "Text", "reading_order": 6 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 107.16, "t": 685.32, "r": 226.44, "b": 656.52 }, "text": "Employee Name", "field_kind": "text", "label": "Employee Name", "pdf_field_name": "Employee Name", "pdf_field_type": "Text", "reading_order": 7 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 465.6, "t": 684.48, "r": 475.08, "b": 675.96 }, "text": "90", "field_kind": "checkbox", "label": "90", "pdf_field_name": "90", "pdf_field_type": "CheckBox", "reading_order": 8 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 491.64, "t": 684.48, "r": 501.12, "b": 675.96 }, "text": "180", "field_kind": "checkbox", "label": "180", "pdf_field_name": "180", "pdf_field_type": "CheckBox", "reading_order": 9 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 508.8, "t": 673.8, "r": 558.24, "b": 660.12 }, "text": "undefined", "field_kind": "text", "label": "undefined", "pdf_field_name": "undefined", "pdf_field_type": "Text", "reading_order": 10 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 465.6, "t": 669.84, "r": 475.08, "b": 661.32 }, "text": "Other", "field_kind": "checkbox", "label": "Other", "pdf_field_name": "Other", "pdf_field_type": "CheckBox", "reading_order": 11 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 287.16, "t": 653.28, "r": 395.64, "b": 623.16 }, "text": "Full-Time Part-Time_Job Title", "field_kind": "text", "label": "Full-Time Part-Time_Job Title", "pdf_field_name": "FullTime PartTimeJob Title", "pdf_field_type": "Text", "reading_order": 12 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 463.8, "t": 653.28, "r": 590.88, "b": 623.16 }, "text": "90 180 Other:_Evaluation Period", "field_kind": "text", "label": "90 180 Other:_Evaluation Period", "pdf_field_name": "90 180 OtherEvaluation Period", "pdf_field_type": "Text", "reading_order": 13 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 107.16, "t": 650.64, "r": 226.44, "b": 621.84 }, "text": "Employee ID #", "field_kind": "text", "label": "Employee ID #", "pdf_field_name": "Employee ID", "pdf_field_type": "Text", "reading_order": 14 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 42, "t": 543.36, "r": 590.64, "b": 473.52 }, "text": "1. 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If so, how do you plan to address them?_Row_1", "pdf_field_name": "3 How do you believe you performed in your role during this evaluation period Are there areas where you believe you could improve If so how do you plan to address themRow1", "pdf_field_type": "Text", "reading_order": 17 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 42, "t": 250.08, "r": 590.64, "b": 176.28 }, "text": "4. Did you meet your professional development goals for this evaluation period?_Row_1", "field_kind": "text", "label": "4. Did you meet your professional development goals for this evaluation period?_Row_1", "pdf_field_name": "4 Did you meet your professional development goals for this evaluation periodRow1", "pdf_field_type": "Text", "reading_order": 18 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 42, "t": 150.96, "r": 590.64, "b": 77.16 }, "text": "5. What suggestions do you have for improving your role, team, or department?_Row_1", "field_kind": "text", "label": "5. What suggestions do you have for improving your role, team, or department?_Row_1", "pdf_field_name": "5 What suggestions do you have for improving your role team or departmentRow1", "pdf_field_type": "Text", "reading_order": 19 } ] }, { "page": 2, "items": [ { "page": 2, "type": "TITLE", "location": { "l": 180.72, "t": 778.56, "r": 477.84, "b": 741.6 }, "text": "Kentucky State University\nNon-Administrative Performance Evaluation", "reading_order": 0, "level": 1 }, { "page": 2, "type": "TITLE", "location": { "l": 43.92, "t": 720, "r": 308.64, "b": 705.36 }, "text": "Section III: Supervisor's Performance Review", "reading_order": 1, "level": 4 }, { "page": 2, "type": "TEXT", "location": { "l": 42, "t": 711.12, "r": 579.6, "b": 666.36 }, "text": "Section III. Supervisor's Performance Review", "reading_order": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 42, "t": 666.36, "r": 579.6, "b": 621.6 }, "text": "Please rate the KSU Employee on each performance factor based on performance of the employee for the evaluation period indicated in Section I. (Employee performance evaluations will not be used to determine merit pay increases) Ratings of excellent and needs improvement require a statement in the comment section explaining the rating.", "reading_order": 3 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 508.8, "t": 657.36, "r": 517.92, "b": 649.2 }, "text": "Employee and supervisor have reviewed and discussed the employee’s current assigned job description", "field_kind": "radio", "label": "Employee and supervisor have reviewed and discussed the employee’s current assigned job description", "pdf_field_name": "Employee and supervisor have reviewed and discussed the employees current assigned job description", "pdf_field_type": "RadioButton", "value": "Off", "reading_order": 4 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 544.8, "t": 657.36, "r": 553.92, "b": 649.2 }, "text": "Employee and supervisor have reviewed and discussed the employee’s current assigned job description", "field_kind": "radio", "label": "Employee and supervisor have reviewed and discussed the employee’s current assigned job description", "pdf_field_name": "Employee and supervisor have reviewed and discussed the employees current assigned job description", "pdf_field_type": "RadioButton", "value": "Off", "reading_order": 5 }, { "page": 2, "type": "TEXT", "location": { "l": 42, "t": 621.6, "r": 579.6, "b": 576.84 }, "text": "Employee and supervisor have reviewed and discussed the employee's current assigned job description. ☐ Yes ☐ No", "reading_order": 6 }, { "page": 2, "type": "TEXT", "location": { "l": 42, "t": 576.84, "r": 579.6, "b": 532.08 }, "text": "Excellent:Employee performs job duties above and beyond work expectations, consistently exceeded performance goals and supervisor's expectations; anticipated and took additional duties beyond major responsibilities. Successful:Employee consistently performed job duties; work and behavior expectations consistently met; met performance goals and supervisor's expectations; completed and verified own work in a timely, accurate and thorough manner. Needs Improvement:Employee did not consistently and/or accurately perform job duties; work and/or behavior expectations were not met; did not meet performance goals and/or supervisor's expectations; not consistently reliable in handling daily duties; requires more supervision than expected.", "reading_order": 7 }, { "page": 2, "type": "TITLE", "location": { "l": 40.8, "t": 532.32, "r": 161.76, "b": 520.32 }, "text": "CORE EXPECTATIONS:", "reading_order": 8, "level": 4 }, { "page": 2, "type": "TITLE", "location": { "l": 40.56, "t": 520.08, "r": 548.88, "b": 495.12 }, "text": "The evaluating supervisor will assess the employee according to their meeting the core expectations listed below. The evaluating supervisor must rate according to the evaluation rating provided above and provide comments where required.", "reading_order": 9, "level": 2 }, { "page": 2, "type": "TABLE", "location": { "l": 42.24, "t": 492.96, "r": 581.04, "b": 45.12 }, "text": "
CORE EXPECTATIONSRATINGEVALUATING SUPERVISOR'S COMMENTS
Dependability: Maintains a strong attendance record, is punctual, and displays a quality work ethic at all times.☐Excellent☐Successful☐Needs Improvement
Job Knowledge and Skills: Understands concepts, methods, and techniques necessary to accomplish job duties.☐Excellent☐Successful☐Needs Improvement
Communication: Actively listens to supervisor and co-workers and expresses feedback effectively and in a professional manner. Maintains a positive and respectful attitude in the workplace toward others and the University.☐Excellent☐Successful☐Needs Improvement
Team Oriented: Works effectively with others to achieve a common goal or complete a shared task. Willing to offer and receive assistance from coworkers as needed.☐Excellent☐Successful☐Needs Improvement
Customer Service: Demonstrates quality customer service to all students, faculty, staff and visitors of the campus.☐Excellent☐Successful☐Needs Improvement
Planning and Productivity: Completes projects and assignments within specified time. Organizes and prioritizes time and University resources appropriately.☐Excellent☐Successful☐Needs Improvement
Adaptability: Is willing to accept change and adapt to differing work processes, conditions, assignments, goals and policies.☐Excellent☐Successful☐Needs Improvement
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Overall Evaluation Rating
☐ Excellent☐ Successful☐ Needs Improvement
PERFORMANCE EVALUATION SUMMARY\nThe evaluating supervisor will determine an overall evaluation rating and provide a brief narrative that summarizes the employee's work performance, accomplishments or areas needing improvement during this evaluation period. If a rating of excellent or needs improvement is chosen, the evaluating supervisor must provide justification for the rating.
Overall Evaluation Signatures
OVERALL EVALUATION SIGNATURES\nThe evaluating supervisor should review the evaluation with the employee and discuss the evaluation ratings. Any ratings of needs improvement, the supervisor will provide the employee an improvement plan.
Print NameSignature
Employee
Evaluating Supervisor
Office of Human Resources
If the employee chooses not to sign the performance evaluation, they should use the employee's comments section or attach additional documentation to explain the reason they do not wish to sign the evaluation.
EMPLOYEE COMMENTS\nThe employee will use the comment section below to make any comments specific professional about their evaluation and supervisor. This area can also be used to explain if the employee does not wish to sign the evaluation.
GOALS\nThe following goals have been agreed to by the employee and supervisor for the next performance evaluation period.\nThere must be at least three goals listed.
1.
2.
3.
4.
5.
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This area can also be used to explain if the employee does not wish to sign the evaluation.", "html_text": "EMPLOYEE COMMENTS\nThe employee will use the comment section below to make any comments specific professional about their evaluation and supervisor. 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