Self Evaluation Form

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EMPLOYEE EVALUATION

Date Evaluation for the period

Employee Name Evaluated by Self-Evaluation and


Immediate Head

Department Current Salary (HR)

Date of Hired (HR) Current Benefit (HR) HMO

Please complete the questions listed below and return to your supervisor prior to your performance
evaluation. As you complete the form, consider your own personal performance as it relates to your
current job description and expectations for the review period.

1. Do you understand the requirements of your job? Yes ___ No ___ If no, what aspects of your job
need clarification?

2. List the expectations for the review period and assess how well you have succeeded in meeting
each expectation. Attach a separate sheet if necessary.

3. What changes in duties or priorities did you face during the review period and how did you handle
them?

4. What are your strengths (the things you do well) and how do you put them to use in your
position?

Page 1 of 2 – Employee Evaluation Form


Confidentiality Notice: This letter and message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender, delete and then
destroy all copies of the original letter and letter.
www.ClarkOutsourcing.com
5. What are your weaknesses (the things you don’t do so well) and how do they impact your job?

6. What would help you enhance your performance (training, equipment, etc.)?

7. What are your expectations for the coming evaluation period?

8. How would you rate your overall performance for this review period?

EMPLOYEE SIGNATURE / SUPERVISOR SIGNATURE


Signature: Signature

Name Name

Date Date

Page 2 of 2 – Employee Evaluation Form


Confidentiality Notice: This letter and message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender, delete and then
destroy all copies of the original letter and letter.
www.ClarkOutsourcing.com
Page 3 of 2 – Employee Evaluation Form
Confidentiality Notice: This letter and message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender, delete and then
destroy all copies of the original letter and letter.
www.ClarkOutsourcing.com

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