UNIVERSITY OF MINNESOTA CROOKSTON
CIVIL SERVICE PERFORMANCE APPRAISAL FORM
Employee Name
Employee ID
Job Class No.
Time Period Being Reviewed
Department Name
Department Entity
Class Title
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Annual Performance Appraisal
Probationary Appraisal
INSTRUCTIONS
Effective evaluation of job performance is an on-going process. Annually, each manager/supervisor is required to provide a summary of progress toward
meeting job expectations. Most employees desire feedback regarding his/her level of performance. The evaluation form has been designed to be used as a
tool to assist you in identifying and communicating employee strengths, areas for improvement, and important work goals.
Part I – Employee self-assessment: The employee should complete this section and submit it to the supervisor prior to the performance meeting.
Part II – Supervisor assessment
 Roles and responsibilities: Reflect key responsibilities/tasks specific to this position. Use the rating scale for each area based on performance
during the evaluation period.
 Competencies: Reflect important competencies relevant to the position. Use the rating scale for each one based on performance during the
evaluation period.
Part III – Work goals for next year/evaluation period: Enter the performance goals for the next period to be evaluated. Individual goals should align with
important department and campus priorities.
PART I: SELF-ASSESSMENT
(To be completed by employee and returned to the supervisor prior to performance meeting)
A. Describe what you consider to be your three major accomplishments during the year that contributed to achieving your department’s goals and strategic priorities.
B. Describe significant challenges you encountered during the year and ways you were able to address the challenge.
C. Review your current job description and either 1) confirm your job description still reflects your regular daily tasks and responsibilities, or 2) identify significant
changes or new responsibilities that should be made to your job description to ensure its accuracy.
PART II: SUPERVISOR ASSESSMENT
RATING SCALE
Rating Level
Examples of Expected Level of Performance
Below are sample benchmarks designed to assist you in consistently evaluating performance and assigning the appropriate level listed in the left hand column.
PART II: ROLES AND RESPONSIBILITIES
Major Responsibilities/Tasks/Objectives
(List major responsibilities/tasks/objectives relevant to
position)
% of Time/
Importance
Performance Results
Performance Level (1-5)
(Summarize how employee performed in terms of quantity, quality, and timeliness of
work.)
Average Score for this Section (1-5)
COMPETENCIES
Competencies Relevant to Position
Performance Level (1-5)
Communication: Demonstrates the ability to express thoughts clearly and concisely; shows good active listening skills; and able to tailor message appropriately to
the audience.
Teamwork: Builds working relationships to solve problems and achieve common goals. Offers assistance, support, and feedback to others.
Motivation: Shows initiative, anticipates needs, and takes actions. Ability to be self-directed, take appropriate action and be efficient and resourceful in fulfilling
responsibilities.
Accountability/Reliability: Takes ownership for own work. Accepts responsibility for mistakes and learns from them. Follows through on commitments, is
dependable and trusted to work independently.
Adaptability/Flexibility: Handles multiple tasks and priorities. Demonstrates cooperation in responding effectively to new or changing situation and assignments.
Average Score for this Section (1-5)
OVERALL PERFORMANCE (1 to 5 ) ___________________
(Add Scores from both parts above and divide by 2)
PART III - GOALS/OBJECTIVES FOR UPCOMING YEAR OR EVALUATION PERIOD
Enter performance goals for the next period to be evaluated. Individual goals and objectives should align with those of the department and campus.
1)
2)
3)
Supervisor summary comments
Employee comments
I have reviewed this document with my supervisor. My signature indicates that I have completed these discussions, but does not necessarily imply my agreement: any areas of disagreement are noted
in my comments above (or in the attached document). I understand that I am entitled to receive a copy of this form.
Employee Signature:__________________________________________________________________________
Date: _____________________
I have provided the employee with a current position description, reviewed applicable work rules, and completed and discussed the performance appraisal with him/her.
Immediate Supervisor: _________________________________________________________________________ Date: _____________________
Next Level Supervisor: _________________________________________________________________________ Date: _____________________