Employee Name: Class Title:
Work Unit: Position Num.:
Social Security
Number:
Period
Covered:
From: To:
The Public Employee Performance
Evaluation System is a planning and evaluation process. The planning portion is intended to identify specific performance expectations that the employee is responsible for achieving during the rating period and the evaluation portion assesses the employee’s performance in achieving expectation standards and goals. The expectations developed during planning are not intended to account for all assignments and work expectations, only those identified as critical or a higher priority. The employee’s performance evaluation will be considered in awarding performance-based salary increases and annual lump-sum bonuses.
This evaluation document may be modified to capture annual, semi-annual or quarterly results.
The intent of the performance process is to note employee progress throughout the year and increase communication between supervisors and employees. At any time, if an employee is not achieving expectations, the supervisor should document any deficiencies in the evaluation, identify corrective actions required by the employee before the next evaluation date and discuss this with the employee.
1 - Employee performance is consistently below expectations.
2 - Employee performance sometimes meets expectations but needs improvement.
3 - Employee performance consistently achieves expectations.
4 - Employee performance often exceeds expectations.
5 - Employee performance far exceeds expectations.
N - No longer applicable/unable to determine
*Employees are expected to reinforce the agency’s mission of . The employee must display the fundamental values of fairness, cooperation, respect, commitment, excellence, honesty and teamwork.
These values have been included as *Performance Expectation #1. Agency may leave this as one
Expectation or choose to break down into multiple Expectations.
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PERFORMANCE E XPECTATION #1
*Employee is expected to demonstrate, model and reinforce the agency’s fundamental values of fairness, cooperation, respect, commitment, excellence, honesty and teamwork. The standard to be applied for this expectation is that the employee demonstrated these values the vast majority of the time in their interactions with co-workers, supervisors, and customers; in the personal contributions to work assignments and projects; and when representing the agency or the State. Employee must have demonstrated these qualities and values consistently in all areas and without fail in order to exceed expectation.
Is expectation linked to agency mission or budget?
NO YES If yes, explain 
1 consistently below expectations
2 sometimes meets expectations but needs improvement
3 consistently achieves
4 expectations often exceeds expectations
5 far exceeds expectations
N - Not applicable
NOTE: If employee was below or exceeded expectations, comments must be provided.
A “1”, “2”, “3”, “4”, “5” or “N” must be checked for each expectation during the evaluation.
5
Midpoint Assessment
4 3 2 1 N 5
Annual Assessment
4 3 2 1 N
NOTE: If employee was below or exceeded expectations, comments must be provided.
PERFORMANCE E XPECTATION #2
(This space will delineate what the performance expectation or core competency is)
Is expectation linked to agency mission or budget?
NO YES If yes, explain 
1 consistently below expectations
2 sometimes meets expectations but needs improvement
3 consistently achieves expectations
4 often exceeds expectations
5 far exceeds expectations
N - Not applicable
NOTE: If employee was below or exceeded expectations, comments must be provided.
A “1”, “2”, “3”, “4”, “5” or “N” must be checked for each expectation during the evaluation.
5
Midpoint Assessment
4 3 2 1 N 5
Annual Assessment
4 3 2 1 N
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NOTE: If employee was below or exceeded expectations, comments must be provided.
2

PERFORMANCE E XPECTATION #3
(This space will delineate what the performance expectation or core competency is)
Is expectation linked to agency mission or budget?
NO YES If yes, explain 
1 consistently below expectations
2 sometimes meets expectations
3 but needs improvement consistently achieves expectations
4 often exceeds expectations
5 far exceeds expectations
N - Not applicable
NOTE: If employee was below or exceeded expectations, comments must be provided.
A “1”, “2”, “3”, “4”, “5” or “N” must be checked for each expectation during the evaluation.
5
Midpoint Assessment
4 3 2 1 N 5
Annual Assessment
4 3 2 1 N
NOTE: If employee was below or exceeded expectations, comments must be provided.
Performance Planning Period Covered: From: To:
This is to acknowledge that the performance expectations contained in this document have been established for the period set forth above.
 Yes This is to acknowledge that the Career Pathing and Enhancement Plan has been completed and reviewed with the employee.
Employee’s Signature: ______________________________________ Date: ________________
Supervisor’s Signature: _____________________________________ Date: ____________________
Supervisor’s Performance Evaluation: From: To:
At any time, if an employee is not achieving expectations, the supervisor should document any deficiencies in an evaluation immediately, identify corrective actions required by the employee before the next evaluation date and discuss this with the employee. This document can be altered for more frequent evaluations as needed.
Employee’s Signature: __________________________________________________ Date: __________________
Supervisor’s Signature: ________________________________________________ Date: ___________________
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Employee’s Signature: ____________________________________________ Date: __________________________
Supervisor’s Signature: __________________________________________ Date: __________________________
Adding the score from each performance expectation and dividing the sum by the number of expectations assessed will provide the employee’s annual performance rating. Note: Expectations assessed as “N” should not be calculated as an Expectation scored.
Calculate as follows: Total of all scores divided by number of expectations scored =
(Annual Performance Rating)
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