May Be Used For Any Classification Prepare in duplicate
Original-Employing Dept. File
Copy to the Employee
Employee Name Department Division
Payroll Title (Class) Date Hired Length of Years Mos Period covered by this evaluation
time in FROM TO
present job
Supervisors Name Supervisors Payroll Title Length of time you Years Mos
have supervised this
employee
PERFORMANCE EVALUATION CHECK ONE Superior
UPER 128 (R7/88) More than Satisfactory
Retn: Office of Record: 5 Years After Separation Satisfactory
Other Copies: 3 - 5 Years After Evaluation Improvement Needed
Unsatisfactory
*Job Responsibilities for Period of Evaluation Comments and Objectives
*Each supervisor and member of the University Management Program who has direct responsibility for meeting established commitments to equal
employment opportunity and affirmative action goals shall be evaluated on his/her good faith efforts in these areas.
Performance Evaluation Form UPER 128 1
Office of the Human Resources
Overall Evaluation Unsatisfactory Improvement Needed Satisfactory More than Satisfactory Superior
Comments
Future Plans and Actions
Your signature indicates neither agreement nor disagreement with the
evaluation, but it does indicate that you have read the evaluation, and it has
been discussed with you. If you wish, you may comment in the space below.
Signature of Immediate Supervisor Date
Employee Comments
Employees Signature Date
Department Head Signature Date
Performance Evaluation Form UPER 128 2
Office of the Human Resources