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Performance Self Assessment
Employee Information
Employee Name:*

last, first, middle
Employee ID:*

Employee Title/Position*

Manager Name:*

last, first, middle
Assessment
List your work related accomplishments and/or contributions for this performance cycle:*

Include any training/developmental classes, projects, completed assignments, and anything else that you think should be included.
What areas of your performance have you been most successful?*

Are there any aspects of your work where you have not done as well as hoped and why?*

(Give examples). What things could be done to improve on these aspects on your part, your managers`s, and the department/organization?
List any training and/or developmental activities that would help you improve your work performance:*

Include activities that enhance your career objectives.
List a particular goal/achievement(s) you would like to complete in the next performance year:*

What guidelines have you set up to accomplish these and how can your manager and the department assist you in achieving these goals?
Does your current Employee Work Profile accurately reflect the duties of your position?*

If not how does it need to be amended?
Additional Comments

Certification and Filing Instructions
I certify that the information that is contained in this report is true and accurate.
Signature:*

fill in your name
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