CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT
PERFORMANCE
EVALUATION
REPORT·
POSITION
Supervisor:
(3-Mo; S-Mo; 9-Mo; Annual; Special; Fmal)
Date of Change if new Supervisor since
last evaluation:
NAME
•.•••
2.
3.
4.
A.D
liB'
The Human Resources Office will provide the supervisor with the Performance Evaluation Report in triplicate. Supervisor and employee must sigo/date all copies.
(If additional space is required, attach a second sheet)
Distribution:
. a. Third copy; Supervisor should give 3nl copy to employee at time of evaluation conference;
b. Second and original copies; Supervisor send 2nd and original copies to next higher person in the administrative channel for review (sigo/date
all copies);
c. Reviewer send second copy and original, signed and dated, to the Human Resources Director for processing and forwarding to the Chancellor
for appropriate action. Original is for permanent retention in employee's personnel file.
Prior to completion of Performance Evaluation Report, it is recommended that supervisor and reviewers review Article 9, Evaluation Procedures, of the SEIU Local
790lDistrict Agreement for unit members.
SPECIAL EVALUATION:
Special evaluation reports may be made at other than the specified times when such are deemed necessary by the supervisor or designated
Manager.
End of 3·Month
recommendation
B.D
A1.6
Period Covered:
Type of Report
1.
III
Date Issued:
#wxxxx
Employee Name: NAME
Position:
CLASSIFIED
Standard
End of 5·Month
recommendation
Probationary
Period.
This employee should continue probationary
employment
or, if applicable, subject to
Period.
This employee should continue probationary
employment
or, if applicable, subject to
Period.
This employee is recommended for REGULAR STATUS at the end of probationary period of 365 days.
(Note: Evaluation report must indicate satisfactory job performance in order for the employee to
successfully complete the probationary period and to achieve permanent status in the position)
in Item E below.
Probationary
in Item E below.
c.D
End of 9·Month
D.D
___
See Paragraph F below; Dismissal recommended
Annual Evaluation. Employee (is) (is not) performing in a satisfactory
Probationary
or
advancement
E·D
Employee should continue employment subject to improvement
follow-up appraisal will be made by supervisor on
F.D
Employee is recommended
G·D
Special Evaluation:
a.
b.
0
0
A. Employee:
or better manner.
I (do) (do not) recommend
this employee for service increment
on hislher anniversary date (if applicable).
in unsatisfactory and/or needs improvement areas on the reverse side of this page. If applicable,
, 20 __
(See Special Evaluation below)
for dismissal, effective
, 20__
.
(May be given at any time)
Employee is recommended
for SPECIAL COMMENDATION
Employee is recommended
for SPECIAL EVALUATION
because of outstanding job performance
because of unsatisfactory
job performance
(See attached written justification.)
(See attached written justification.)
I have read and received a copy of this Performance Evaluation Report. In signing this report I acknowledge that I have read it and understand the contents.
My signature does not necessarily indicate agreement. I understand that I have five (5) working days, after signing this evaluation, to file an appeal. See
SEIU Local 7901District Agreement.
Dare
Signatwe - Employee
B. Supervisor:
I have discussed this evaluation with the employee on date indicated.
Dare .
Signature - Supervisor
C. Reviewed by:
_
Reviewer Signature
Dale
Reviewer Supervisor
Dare
Reviewer Supervisor
Dare
D. For Appropriate Action:
P'J£§idsp'
Human Resources Office
Revised 12106
(please initial
R@Vi
& date)
Q'pS';J'w
Parn
ijuwpp Re:P"wm
Pam
JOIl RELATED PERFORMANCE
AREAS
(Check one Iating for each lierfonnance Area)
I~ttJ ...., ..out. acontribution
..
of
work.,
standards
IAbscQt
to
Undcpendab1e
extra<:Ompeteutin
District
holdthcjoh
of
cOncem..
meat
asset
to
the
District.
Amount
of
work
is
~.Doesnot
.More
than
occasional
Has
to
be
led.
Does
not
IndiistrioDsDeSsof
Almost
~
athe
iource
aor
0010
do
that
little
bit
reasonable
beCome
amount
needed
enough
to
be
left
almost
quality
than
most
An
Quality
late
only
with
iood
tt?
Skilled
wod=
DOW.
more
waste
at
en:ors
...No
prodded
Should
be
able
be
supeMscd.
Conscientious..
Diligent.
~ow
~
effort
unless
SQmCtimes
A
always
pOsitive
above
factor'
upsets
av~
~
KnoWS
the
job
well
pt'Ogre.$S
further.
consistently
meet
Consistently
bctler
completely
independent
Does
just
enough
to
get
Justenoilgh
know1cdgc
.'not.Qf
or
rejects
Work
can
be
Respected
wait
forhU1Dlll1
levels,
othcn.
morale..~
c»-worleers,
Needs
improvoup
with
that
little
bit
Self-.stattCF.Does
along
we11l1tall
to
by
get
..AImost
by..Must
never
always
comes
Much
imProvement
e~detaiI..
A
top
level
worlcer.
loo
abaences,
Job
has
toto
be
chec:bd
Marginal
emp19Yee.
reWionships.
.amount
job. llIr'lIiness.
b~job
and
virtually
Couip~y~
needs
be
supervised.
~ws in
a usigDluenti.
top present
Potential
Careless
about
Does
not
the
wode.
know
job
to
Worlc
euoJlgh
make
amost
Gets
cbance..
pmscientious..
A
liIrdy
wit4
Always
·Thorough
knowiedge
of
experience
!U!drraining,.
An~wbo~
~
C8J1didatefor
assigument.
iO.ini
than.shOWDby
as
an
example
most
fOf
Doesn't
ity.
consistently
turn
work
consistently
but
Knows
details,
mast~fthe
but
needs
more
~level~
extri.
to
Show'fuIl
effort
~plc.
N"osignificant
high~··~wais
Il:8SOIIIIb~~i1Does
average·
amount
of
problems.
Can
always'!le
Counied
Quantity
Reasonably
reliab~e.
beyond
pcescutjob.
AdeQwlII!l
paI~
crformaIu:c.
Initiative
surely
go
beyond
waste
.Only
r.=
Has
amany
Ie!ISOlllible
Ordinaly,
average,
Does
woc:king
no
more
bard.
than
is
.
.
group
mQIJ1e.
*UusatistactoryD
*UlJSatistactory"
A
negative
f~
in
PERFORMANCE
Unreliable.
ExceSsive
Satisfactory
Probably
Sa&ractory
Sa&ractot1
Satlsfactory
will
not
be
D
N~
Improyement
Needs
Good
Improvement
G~D
.ExcelientO
Exc:e1lent
ExceI1~tD
.
*Unsatisfactory
'. .
1II Excellent
Satfsfacto~
ImJ)roT~en~
:.1
GoodD
Neeps.
ExceDenfD
"1
Neecls
~D
Jmpro't;lJlent
*~nsatlsfaetlil1
Needs
Improv~ent'O
~tO
Needs
~UDSatis.ractoI1
Improvement.0D
*UDS8~etory
~tisfactory
*Unsatfsfaetorv
SatisCactorvD
dNOT
r ...
",
..
00000. 00
0 00
q
"
!Xl
.,
1
..
.
others
prod~on.
imd~.·
,
.
..
.
"
..
-
.
ju$tificatiOD.
"
COMMENIS:
IMPORTANT:
.
*UNSA TISFACfORY Iatings must be accompanied by a WIittea statement from the supervisor indicating specific
~on(sj
for the~atisfactoIY rating(s).··