Employee Name:
Title:
Employee ID:
Time in position:
Department/
School/Unit:
Review Period:
Supervisor:
Time under rater’s
supervision:
Exempt Employee Performance Review Form
Meets Standards:
The staff member performs work requirements accurately, completely and timely. Demonstrates works
skills that consistently meet and on occasion exceed job expectations in performance. Manages work
efficiently; identifies problems and issues with adequate solutions; communications are appropriate for
the defined audience; works respectfully with others; and meets commitments.
Does Not Meet
Standards:
The staff member fails to perform work assignments that meet job requirements or standards. Staff
member needs frequent supervision and direction, quality and/or quantity does not meet job standards
and performance is below expectation.
Does Not Meet Standards
The staff member’s work is consistently above the standards for this position. Demonstrates broad
knowledge of the functional area; identifies critical issues and provides proposed solutions; plans and
organizes work with limited supervisory help; communications are clear and concise; promotes
teamwork; suggests improvements to policies and procedures; meets a high standard of accountability.
Meets Standards
Exceeds Standards:
Exceeds Standards
Part I: Performance Standards
1. Professional Knowledge: Ability to demonstrate knowledge of functional area and skills
needed for effective performance of responsibilities.
2. Professional Judgment/Analytical Ability: Ability to evaluate situations and select courses
of action that reflect sound institutional thinking.
3. Organization and Planning: Ability to systematically structure tasks, make plans and set
objectives, establishes priority and schedules, and use record keeping systems.
4. Quality of Productivity: Ability to produce work that is dependable, accurate, contributes to
accomplishment of department goals.
5. Oral and Written Communication: Ability to clearly express facts, ideas or thoughts.
6. Working Relationships: Ability and willingness to collaborate with colleagues to accomplish
goals and support institutional initiatives.
7. Initiative: Ability to independently identify and complete work or projects.
8. Application of Policies and Procedures: Ability to understand, adhere to and communicate
established policies and practices.
9. Accountability: Accepts responsibility for commitments, acts in best interest of CUA
community and takes initiative.
Meets Standards:
Staff Member receives no more than TWO (2) Does Not Meet Standards.
Does Not Meet
Standards:
Staff member receives THREE (3) or more Does Not Meet Standards.
Any staff member that has an overall rating of “Does Not Meet Standards” in Part I, must be placed on a Performance
Improvement Plan. The Rater must contact The Office of Human Resources for support.
Does Not Meet
Standards
Staff member receives FIVE (5) or more Exceeds ratings with no Does Not Meet Standards.
Meets Standards
Exceeds Standards:
Exceeds Standards
Scoring for Part I:
Overall rating:
Comments:
Revised 7/6/2015
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Meets Standards
Does Not Meet
Standards
Does Not Meet
Standards
Does Not Meet
Standards:
Meets Standards
Meets Standards:
Exceeds Standards
Exceeds Standards:
Exceeds Standards
Part II: Support for CUA Values:
Integrity: Shows consistency between words and actions; accountable; Lives up to
commitments; Respects confidentiality; Treats people fairly; Risks doing the right thing;
Applies sound work ethics and standards; Ensures employment laws are followed and equal
opportunity, safety and environmental protection are practiced.
Respect: Manages difference effectively; Encourages colleagues to express their views and
facilitates discussion and resolution of different views; Expresses disagreement tactfully and
sensitively; Recognizes talents and accomplishments of others.
Excellence: Establishes and maintains high work standards; Possesses and applies relevant
knowledge, skills and abilities; Produces measurable results with appropriate level of effort;
Recognizes achievements of others; Aligns work objectives with institutional goals.
Service: Decisions and work processes incorporate the interests and needs of those served;
Approachable, accessible; Coaches, counsels and motivate others; Shares talents and
expertise.
Community: Willingly takes on projects that benefit CUA community; Effectively builds teams
and seeks members with complementary skills; Communicates effectively with people at all
levels of CUA community; Empowers individuals and teams.
Scoring for Part II:
Exceeds Standards:
Staff member receives THREE (3) or more Exceeds ratings with no Does Not Meet Standards.
Meets Standards:
Staff Member receives no more than ONE (1) Does Not Meet Standards.
Does Not Meet
Standards:
Staff member receives TWO (2) or more Does Not Meet Standards.
Any staff member that has an overall rating of “Does Not Meet Standards” in Part II, the areas that were rated “Does Not Meet
Standards” must be addressed in “Goal Setting” for the upcoming rating period. The Rater should contact the Office of Human
Resources for support.
Overall rating:
Comments:
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Part III. Mandatory Training Requirements: Indicate those required training modules that have been
completed during the review period.
FERPA Awareness (required every 2 years)
Date Last Completed:
HARASSMENT Prevention (required every 2 years)
Date Last Completed:
COMPLIANCE (required every 2 years)
Date Last Completed:
Privacy and Information Security (required every 2 years)
Date Last Completed:
Part IV. Acknowledgement
I acknowledge by my signature that I have read this evaluation and have discussed it with my
supervisor. In addition, I acknowledge that I am aware of the CUA Code of Conduct.
Employee’s Signature:
Date:
I have discussed this evaluation with the employee
Rater’s Signature:
Date:
Rater’s Name (Print)
I have reviewed the evaluation
Unit/Department Head’s Signature:
Date:
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Goal Setting for Upcoming Evaluation Period
Goal or Area for Development
Task and Measurement
Revised 7/6/2015
Target Dates
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