Page Numbers: Yes X: 4.75" Y: -10.50"
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XEROXXEROX PERSONAL DATA

EXEMPT SALARY PROGRAM PERFORMANCE APPRAISAL

Name: Name

Title: Title

Division/Department: General Sciences Laboratory

Period Reviewed: From Jan. 1, 19XX To Jan. 1, 19XX

PLEASE NOTE

This booklet is provided to assist you in your review of the individual’s major activities and in an appraisal of the effectiveness in each of them. In other words, you are asked to state what the individual has been doing and what results have been achieved before you recommend or deny a salary increase. Please base your comments on those activities of which you have personal knowledge during the period under review.

1.Performance Appraisal

(A)In this column please have the incumbent describe only the major activities the employee has been engaged in during this period. They must be listed in order of importance.

(B)After reviewing and verifying the accuracy of the statements in column (A) please give in some specific detail your opinion of the relative success the employee has had in handling each of these. Make a special effort to mention the degree of achievement (i.e. adequacy) and any factors beyond the employee’s control which might have contributed to the observed results. Where possible use objective data from operational statements such as profits, budgets, sales, new products, schedules, costs, etc.

(A) ACTIVITIES(B) APPRAISAL

1.Use this paragraph to fill in your comments. Be sure to input all text in Look Hardcopy. This paragraph is set up with: Margins: F: 85pt P: 103pt R: 332pt, Lead: X: 1pt Y:10pt, Vertical Tab:644pt.

2.Use this paragraph to fill in your comments. This paragraph is set up with: Margins: F: 85pt P: 103pt R: 332pt, Lead: X: 1pt Y:10pt.

1.Your Manager is to use this space to fill in his comments. This paragraph is set up with: Margins: F: 341pt P: 363pt R: 575pt, Lead: X: 1pt Y: 10pt, Vertical Tab: 644pt. You should perform the aligning of employee comments with manager comments to each item number by adding blank lines to which ever is longer until both comment sections are equal in total lines used.

2.Your Manager to use this space to fill in his comments. This paragraph is set up with: Margins: F: 341pt P: 363pt R: 575pt, Lead: X: 1pt Y: 10pt. NOTE: this paragraph DOES NOT carry a vertical tab.

(A) ACTIVITIES(B) APPRAISAL

#.FOR FIRST SECOND PAGE COMMENTS ONLY. Use this paragraph to fill in your first second page comments. This paragraph is set up with: Margins: F: 85pt P: 103pt R: 332pt, Lead: X: 1pt Y:10pt and a vertical tab of 10.65".

#.Use this paragraph for inputting the rest. It does not carry a vertical tab. You may want to align both comment columns by setting the a vertical tab to both first paragraph comments.

#.FOR FIRST SECOND PAGE COMMENTS ONLY. This paragraph is set up with: Margins: F: 341pt P: 363pt R: 575pt, Lead: X: 1pt Y: 0pt, and a vertical tab at 10.65".

#.Use this paragraph for inputting the rest. It does not carry a vertical tab. You may want to align both comment columns by setting the a vertical tab to both first paragraph comments.

(C)List any duties formally assigned to the individual which should have been, but were not carried out. Give your opinion on why the employee was unable or failed to engage in these activities.

ASSIGNED ACTIVITIES NOT CARRIED OUTREASON NOT PERFORMED



(Must be completed for all Managers -
See Guide to Completion #10, Special Note)

ADDITIONAL COMMENTS

Manager to fill out. This paragraph carries: Margins: L: 99pt R: 513p, Lead: X: 1pt Y: 10pt.

SUMMARY APPRAISAL

11111

Unsatisfactory Less Than ExpectedExpected LevelConsistently Exceeds ExpectedExceptional
PerformanceLevel of Performanceof Performance Level of PerformancePerformance

Approved by:

Title:Date:

Additional Approvals:

EMPLOYEE REVIEW OF THE PERFORMANCE APPRAISAL:

I have reviewed this appraisal and discussed the contents with my manager. My signature means that I have been advised of my performance and does not necessarily imply that I agree with the appraisal or the contents.

Employee’s Signature:Date:

Employee’s Comments: (Optional: If employees wish to do so, any comments concerning the appraisal or the content, for example, agreement or disagreement, may be indicated in the space provided below. If employees disagree with the appraisal, they have the option of contacting the second level manager. If employees still have questions, they then have the option of contacting Personnel.)