Not Mee ng. The employee is not mee ng expecta ons or goals.

Form 34020 Available at: h p://www.hr.umich.edu/hrris/forms/pdfs/sta evalua on.pdf Revised 1/2015

First Name: Middle Name:

UMID: Department Name:

Last Name:PERSONAL INFORMATION

Exemplary. The employee considerably and consistently surpasses expecta ons and goals, and achieves beyond regular assignment in all areas throughout the performance cycle.The employee is a role model for others and demonstrates mastery of skills and tasks involved.

Page 1 of 2

SUMMARY EVALUATION OF PERFORMANCE (Addi onal lines provided on following page.)

Department ID:

Date Evalua on Discussed with Sta Member:

Period Covered in Evalua on Date from:

Period Covered in Evalua on Date to:

Reason for Evalua on:

STAFF MEMBER EVALUATION

Successful. The employee is fully competent and e cient in role.Employee regularly meets and some mes surpasses expecta ons and goals.

Developing. The employee is in the learning curve and has not mastered key job responsibili es.ORThe employee is neither consistently competent nor e cient.

Form Form HR34020HR34020

Form 34020 Available at: h p://www.hr.umich.edu/hrris/forms/pdfs/sta evalua on.pdf Revised 1/2015

Page 2 of 2

SUMMARY EVALUATION OF PERFORMANCE (Con nued from previous page.)

Sta Members Signature: Date Signed:

Supervisors Signature: Date Signed:

Dean, Director or Representa ve Signature: Date Signed:

The sta members signature, which is required, indicates that the sta member has reviewed and discussed the evalua on with the supervisor. It does not necessarily imply agreement with the evalua on.

SUPERVISORS COMMENTS/SUPPORTING STATEMENT

STAFF MEMBER EVALUATION

First Name: Middle Name:Last Name:

EMPLOYEES COMMENTS/SUPPORTING STATEMENT

Self-Evalua on: _______________ (Determined by employee)

Overall Achievement Level: _______________ (Determined by supervisor)

Form Form HR34020HR34020

UMID: Department Name: Department ID: Reason for Evaluation: Evaluation Date From:: Evaluation Date To:: Evaluation Date Discussed:: Exemplary: Exemplary Summary: Successful: Successful Summary: Developing: Developing Summary: Not Meeting: Not Meeting Summary: Last Name:

First Name:

Middle Name:

Summary Evaluation of Performance: Self-Evaluation: Employee's Comments: Supervisor's Comments: Supervisor Date Signed: Director Date Signed: Staff Member Date Signed: Overall Achievement Level: