08568 Mercer Blvd
Charlevoix, MI 49720
231.582.8070 Fax 231.582.8082
STUDENT WORK EVALUATION FORM
Student/Employee:________________________________________
Business/Employer: ____________________________________
School:_________________________________________________
Training Site:_________________________________________
Teacher:________________________________________________
Supervisor:___________________________________________
Teacher Phone number: ___________________________________
Supervisor Phone number: ______________________________
Please rate the student based on the following work behaviors.
1= Poor
2 = Below
3 = Average
4 = Above Average
5 = Excellent
Skills
Supervisor
Attendance:
1. Does the worker come to work on a regular dependable basis?
2. Does the worker communicate schedule conflicts ahead of time and notify the employer?
3. Does the worker come to work on time and stay the full shift?
Self-Direction:
1. Does the worker finish the assigned task or job before starting a new task or socializing with co-workers?
2. Does the worker recognize correct completion of task?
3. When finished with the assigned task, does the worker ask what to do next or move on to another task rather
than stand around watching others or waiting for another task?
Displays Proper Respect:
1. Is the worker courteous and polite?
2. Does the worker treat you, co-workers, and customers in an acceptable manner?
3. Does the worker treat machinery equipment and work materials with care?
Instructions:
1. Does the worker demonstrate understanding of your instructions, both verbal and written?
2. Once the worker understands instructions, are the instructions carried out satisfactorily?
Cooperation:
1. If you inform the worker of something that is being done incorrectly, does the student take it in stride and
attempt to correct the error?
2. Can the worker function without interfering with others?
3. Is the worker willing to help others when asked and let others help the student?
General Appearance:
1. Does the worker keep themselves clean and odor free?
2. Does the worker dress appropriate to the job site?
Rules of the Job:
1. Is the worker aware of the regulations for the work site and job?
2. Does the worker obey these regulations?
Basic Skills:
1. Does the worker demonstrate necessary reading, math, and writing skills for the job and the required job
specific skills?
General Attitude
1. Is the worker enthusiastic and positive towards the work experience?
2. Does the worker fit into the group or situation?
3. Does the worker show willingness to learn new methods and to improve work skills?
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Supervisor Signature: _______________________________________________ Date: ____________________
Student/Employee Signature: _________________________________________ Date: ____________________
Coordinator’s Signature: _____________________________________________ Date: ____________________
NOTICE OF NONDISCRIMINATION: It is the policy of the Charlevoix-Emmet Intermediate School District to comply with all federal
laws and regulations prohibiting discrimination. Char-Em ISD does not discriminate on the basis of race, color, national origin, age, sex,
marital status, religions, disability, language, diversity or lack of English language skills. For more information contact the Civil Rights
Coordinator at 231-547-9947.
Distribution: White Copy – School
Revised 11/5/2013
Yellow Copy – Parent/Student
Pink Copy - Business