Name:____________________________________ Date:__________________________________

CORE COMPETENCIES
Integrity and Trust                      Meets ____%                  Doesn’t Meet ____%

Mission Integration                      Meets ____%                  Doesn’t Meet ____%

Team Relations                           Meets ____%                  Doesn’t Meet ____%

JOB SPECIFIC COMPETENCIES               
            Exceeds _____               Meets ____                    Doesn’t Meet ____   

Job Description
            Exceeds _____               Meets _____                  Doesn’t Meet ____

PROFESSIONAL GOALS:

To qualify for a merit increase, meets or exceeds must be marked in ALL areas above.  IF all areas are marked MEETS or EXCEEDS, please sign and date below.

If Doesn’t Meet in any area, a work plan must be agreed upon at this time and copy attached to this document

Summary comments:

EVALUATION COMPLETED BY: 

Supervisor: _____________________________ Date: ____________________________________

My signature indicates that I have received this performance review and that I have reviewed the job description and competencies.  My signature indicates that I understand the expectations listed in both the job description and competencies. 

Employee _______________________________Date:_____________________________________

Comments:

Signature of CEO:________________________Date:______________________________________