Name:
ANNUAL PERFORMANCE REVIEW
Division: Supervisor:
Title:
Magis – focus on students; encourage and model personal accountability and high performance; use resources efficiently and strategically; act with integrity
Department: Fiscal Year:
Cura Personalis – encourage balance in our professional and personal lives; build trust through ongoing feedback; recognize and utilize individual styles and skills; treat people with respect regardless of position
Performance does not meet many job requirements on a consistent basis .
1 = Need for Development
Critical goals require more than usual supervisor follow-up and direction. Results and contributions are below those of a fully trained competent employee. Action on performance improvement areas is required .
Performance Rating Scale
2 = Competent
Performance consistently meets and sometimes exceeds job requirements. All critical goals are achieved and behaviors exhibited are valued and effective. Over the review period, employee has made the expected contributions to the department. Consistently met expectations for the performance of duties and responsibilities identified.
3 = Exemplary
Performance and demonstrated expertise is consistently at a superior level. Employee achieves outstanding results and models effective behaviors that are an inspiration to others. Over the review period, employee has consistently made exceptional or unique contributions to the department. Regularly exceeded expectations for the performance of duties and responsibilities identified.
SECTION 1. Institutional Values and Competency Evaluation
At Xavier, we celebrate a passion for mission and incorporate those values into one’s performance. Competencies are demonstrated knowledge, skills, abilities and motivations. Ratings are based on observations of the immediate supervisor with input from others whom the employee worked with during the review period.
INSTITUTIONAL VALUES
Discernment – make important decisions with broad consultation; consider the full impact of our actions; manage conflict constructively
Reflection – are self-aware and understand strengths and weaknesses; encourage and model personal growth, evaluation and learning; challenge the process and status quo as appropriate; accept responsibility for our actions
Solidarity and Kinship
– develop strong relationships within and outside of Xavier; value diversity of people, ideas and ways of thinking; motivating others and offer assistance with your talents
Service Rooted in Justice and Love
– contribute service time in the way of treasure and talents with others; support those in need; help others become men and women for others
SECTION 1. Xavier’s Institutional Values Comments:
Please provide specific examples of how Xavier’s institutional values were exhibited in the work setting. Discuss strengths and opportunities for improvement. The employee should provide a selfassessment of ‘living the values’ at Xavier.
Supervisor Comments:
OVERALL VALUES RATING
Provide one overall rating from scale of 1-3
Supervisor
Employee Comments:
OVERALL VALUES RATING
Provide one overall rating from scale of 1-3
Employee

ANNUAL PERFORMANCE REVIEW
CORE COMPETENCIES
Leadership – creating a healthy work environment that encompasses developing or promoting a workplace climate conducive to productivity and self-motivation; trustworthy behavior by demonstrating through personal behavior that one is ethical and trustworthy; clearly articulating goals and objectives to colleagues and direct reports; results oriented, focuses work efforts on achieving positive results within one’s area of responsibility
Collaboration –
Establishing and maintaining collegiality and cooperative working relationships with other members of the University; Involving others by engaging colleagues, direct reports and other coworkers or stakeholders by sharing information (e.g. through reports, meetings, presentations or by other means based on job responsibility); coaching and supporting others in their skill building and by providing information, resources and tools to enable them to be successful; soliciting input and asking for ideas and/or feedback from others in appropriate settings such as meetings, phone calls and presentations
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee Supervisor
Managing Work – effectively organizing and carrying out work processes to achieve individual and organizational goals through necessary means such as setting priorities and making appropriate decisions to complete assigned tasks while balancing urgency and important; making decisions and analyzing data and information to make informed timely decisions and appropriately disseminating those decisions to others; and problem solving through balancing facts and people issues effectively to resolve problems and meet organizational concern
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Effecting Change – developing and supporting processes that bring about positive change in support of University’s goals; empowering others with the ability to change processes that pose barriers to change; willing to accept challenges and modify processes, procedures and behaviors as needed; willing to take appropriate risks and make decisions based on incomplete or ambiguous information
Supervisor
Job Specific Competency #1:
COMPETENCY RATING
Rate each competency on scale from
Employee Supervisor
COMPETENCY RATING
Rate each competency on scale from
Employee
Job Specific Competency #2:
1-3
1-3
Supervisor
Communicating – using non-verbal communication and showing respectful behavior toward colleagues and others in the University; actively listening and focusing on the person speaking, asking questions and providing feedback to ensure understanding; teaching and sharing knowledge and information with others; promoting dialogue with others and uncovering and discussing concerns and objections
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee Supervisor
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee Supervisor
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee Supervisor
SECTION 1. Competency Evaluation Comments
Please provide specific examples of how Xavier’s core competencies were exhibited in the work setting. Discuss strengths and opportunities for improvement. The employee should provide a selfassessment of exhibiting these competencies at work.
Supervisor Comments:
OVERALL COMPETENCY RATING
Provide one overall rating from scale of 1-3
Supervisor
Employee Comments:
OVERALL COMPETENCY RATING
Provide one overall rating from scale of 1-3
Employee

ANNUAL PERFORMANCE REVIEW
SECTION 2. Organization Objectives & Job Responsibilities
Objectives are goal related, LINKED to University goals and SMARTRR ( S pecific, M easurable, A ttainable, R elevant, T imebound, R eview/Adjust, and R ejoice in Achievements) and job responsibilities are outlined in employee’s position description. This section is to allow you to evaluate ‘what’ employees have accomplished this year that includes a combination of objectives and job responsibilities.
Organization Objectives
Objectives:
Measure(s):
Objectives:
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
Objectives:
Measure(s):
Objectives:
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
Objectives:
Measure(s):
Objectives:
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
Objectives:
Measure(s):
Objectives:
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
Section 2. Organization Objectives Evaluation
Please document employee’s goals and objectives for the review period and provide comments of ‘what’ work was done to accomplish these goals and objectives. The employee should provide selfassessment of annual accomplishments. The immediate supervisor will provide a rating based on documented results with input from others whom the employee worked with during the review period.
Also include strengths and suggestions for improvement.
Supervisor Comments:
OVERALL OBJECTIVE RATING
Provide one overall rating from scale of 1-3
Supervisor
Employee Comments:
OVERALL OBJECTIVE RATING
Provide one overall rating from scale of 1-3
Employee

ANNUAL PERFORMANCE REVIEW
Job Responsibilities
Job Responsibility:
Measure(s):
Job Responsibility:
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
Job Responsibility:
Measure(s):
Job Responsibility:
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
Job Responsibility:
Measure(s):
Job Responsibility:
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
Job Responsibility:
Measure(s):
Job Responsibility:
Measure(s):
Section 2. Job Responsibilities Comments
Please document employee’s job responsibilities for the review period and provide comments of ‘what’ work was done to fulfill these responsibilities. The employee should provide self-assessment. The immediate supervisor will provide a rating based on documented results with input from others whom the employee worked with during the review period. Also include strengths and suggestions for improvement.
Supervisor Comments:
OVERALL JOB RESPONSIBILITIES RATING
Provide one overall rating from scale of 1-3
Supervisor
Employee Comments:
RATING
Rate each competency on scale from 1-3
Employee Supervisor
RATING
Rate each competency on scale from 1-3
Employee Supervisor
OVERALL JOB RESPONSIBILITIES RATING
Provide one overall rating from scale of 1-3
Employee

ANNUAL PERFORMANCE REVIEW
Performance Rating Scale
1 = Need for Development
Performance may meet some but not all requirements on a consistent basis . Critical goals require more than usual supervisor follow-up and direction. Results and contributions are below those of a fully trained competent employee. Action on performance improvement areas is required .
2 = Competent
Performance consistently meets and sometimes exceeds job requirements. All critical goals are achieved and behaviors exhibited are valued and effective. Over the review period, employee has made the expected contributions to the department. Consistently met expectations for the performance of duties and responsibilities identified.
3 = Exemplary
Performance and demonstrated expertise is consistently at a superior level. Employee achieves outstanding results and models effective behaviors that are an inspiration to others. Over the review period, employee has consistently made exceptional or unique contributions to the department. Regularly exceeded expectations for the performance of duties and responsibilities identified.
Section 3. Overall Performance Rating
A single performance rating will be determined based on a combination of ratings in Section 1 & Section 2. Please check the box below that applies to the employee you are evaluating.
Need for Development Competent Exemplary
Employee Signature* / Date: Supervisor Signature / Date:
(Signature indicates the material was reviewed and discussed)
*Note: Your signature does not necessarily indicate agreement with the contents of this form, but is a confirmation that you have met with your immediate supervisor to discuss your performance.
Completed review of my position description.
3/2013