2014 Self-Evaluation of Performance
1/1/2014 – 12/31/2014
Send this completed document to your supervisor no later than
February 9, 2015
Employee Name
Job Title
Division/Office
Date
Routing the Self-Evaluation Form
1. Complete this self-evaluation form and save it to your network drive. Print a hard copy,
sign, and give it to your supervisor by Monday, February 9, 2015.
2. This form should be reviewed and signed by both you and your supervisor at your
performance review meeting.
3. After your performance review meeting, your supervisor will forward this original, signed
form to Personnel Administration along with the updated list of your job duties and
responsibilities and your supervisory evaluation form.
PART I – 2014 ACCOMPLISHMENTS
Describe your most significant accomplishments in 2014.
Describe any barriers or challenges that impacted you in effectively completing your job
responsibilities or accomplishing your goals.
Is there any information you would like to share with your supervisor regarding your work
performance in 2014?
PART II – 2015 GOALS
What personal or job related goals and objectives do you have for yourself in the coming year?
What skills or new knowledge would you like to develop to improve your performance? These
items should include skills training and/or professional development goals.
JOB RELATED GOALS
If an opportunity presented itself, is there a different, specific area in which you would prefer to
work at the campus? Is there a specific project in which you would like to participate and lend
expertise? Are there any other tasks you would like to assume in the upcoming year? Please
explain.
PART III – DIVERSITY
IUPUC is committed to being an inclusive community and believes that multiple perspectives and
experiences are essential to learning. Through our programs and practices, we seek to foster the
understanding of and respect for cultural differences necessary for an enlightened and educated
citizenry. All employees play a part in creating a culture that welcomes people of all backgrounds.
Give examples of ways that you believe you can contribute to a better understanding of diversity
and create a more welcoming environment for everyone at IUPUC.
ADDITIONAL COMMENTS
This section is for employee comments only and is optional.
Employee’s Signature/Date
Supervisor’s Signature/Date
Print Name
Print Name
Note: Supervisor’s signature verifies the content of the document has been read. It does not
necessarily imply agreement with the contents.