Fill and Sign the Employee Performance Appraisal Form Epa 3 Wv Division of

Human Resources DivisionEMPLOYEE PERFORMANCE APPRAISAL SUMMARY INSTRUCTIONS: Finalize the annual Employee Performance Appraisal form. Then complete and forward this Performance Appraisal Summary form only to the { Insert Address}. Name Of Employee (First, MI, Last) Social Security No. Employee Classification Title Planning Date Name of Evaluating Supervisor Name of Hiring Authority Mid-Year Evaluation Date PositionLocation:Division District No. County Annual Evaluation Date SECTION I RESPONSBILITIES/ OBJECTIVES PERCENTVALUE RATING 1 Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory 2 Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory 3 Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory 4 Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory 5 Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory 6 Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory 7 Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory OVERALL RATING Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory SECTION IA MANAGERIAL VALUES RATING Managing Mutual Respect/Diversity Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryManaging Employee Performance Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryCommunication Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryLeadership Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory OVERALL RATING Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryCOMBINED I AND IA RATING Exceeds Expectations Fully Achieves Expectations Needs Improvement Unsatisfactory SECTION II PERFORMANCE VALUES RATING Teamwork Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryDependability Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryCustomer Service Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryJudgment Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryMutual Diversity/Respect Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryOVERALL RATING Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryCOMBINED I, IA AND II RATING Exceeds Expectations Fully Achieves Expectations Needs Improvement UnsatisfactoryEXTENSION OF RATING PERIOD: Please explain the reason for extending the rating period. CERTIFICATION I, the undersigned employee, certify that this performance appraisal has been discussed with me and I have been given the opportunity to comment in writing. I understand that my signature does not constitute agreement.Date of Annual Evaluation Review Signature of EmployeeDate of Annual Evaluation Review Signature of Evaluating SupervisorDate of Annual Evaluation Review Signature of Hiring Authority