Title Page
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Date and Time of Review
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Department
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Employee (Full Name)
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Employee Number
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Job Title
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Supervisor (Full Name)
Self-Assessment
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What were your most significant work-related accomplishments? (Include projects, assignments, new skills or knowledge gained.)
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How do these accomplishments relate to your key responsibilities and goals for you and your unit/department?
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What didn’t you accomplish that you had planned on accomplishing? Why?
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What are your goals for the next evaluation period?
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How will you accomplish these goals?
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What do you need to accomplish these goals?
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How can your supervisor help you to work more effectively and support your goals?
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How can your team help you achieve your goals?
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What additional training or development would help you improve and/or enhance your work performance?
Completion
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What feedback or suggestions do you have to improve your unit and/or department?
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Employee (Full Name and Signature)
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Supervisor (Full Name and Signature)