ࡱ> U@ %bjbj .d~~~~~~~rrrr4v L Z!4P!----P4.D1T4$5R8x4~% %%x4~~ 4'''% ~ ~ -'%-'*'2()h~~B* j PS:r%R"*^*4042*8&8 B*$~~~~8~B*l!6"'"t:#xl!l!l!x4x4r'r State of Connecticut Human Resources EMPLOYEE SERVICE RATING ADMINISTRATIVE AND RESIDUAL (P5) UNIT Form #: Per 127 Revision Date: 3/2000 INSTRUCTIONS: Read instructions on reverse Side carefully before completing this report. TO: Human Resources Business Center, Dept. of Administrative Services, 165 Capitol Avenue, Hartford, CT 06106TYPE OF SERVICE RATING  FORMCHECKBOX  INITIAL PROBATIONARY  FORMCHECKBOX  ANNUAL  FORMCHECKBOX PROMOTIONAL  FORMCHECKBOX OTHER (Specify) EMPLOYEE NAMECLASS TITLEDEPARTMENT OR INSTITUTIONPERIOD COVEREDFROMTOAI DATE FACTORS Good or Better Less Than Good DEFINITION OF RATINGS Evaluate the employee on the job now being performed based on the report period. Check (x) the rating category which most nearly describes your overall judgment for each of the job factorsEXCELLENTSUPERIORSATISFACTORYFAIRUNSATISFACTORYEXCELLENT = Distinctly and consistently outstanding. SUPERIOR = Definitely above the norm. SATISFACTORY = Meets basic requirements FAIR = Need for improvement. UNSATISFACTORY = Definitely inadequate. NOTE: Written explanations are required for ratings of Less than Good, and they are recommended for ratings of Excellent.QUALITY OF WORK: Thoroughness, accuracy and appearance of work, regardless of volumeEXPLANATION _______________________________________________________________________________________________ SUGGESTIONS FOR IMPROVEMENT QUANTITY OF WORK: The amount of work produced under normal conditions, disregarding errors, and giving full consideration to contributions in all official areas.EXPLANATION _______________________________________________________________________________________________ SUGGESTIONS FOR IMPROVEMENT DEPENDABILITY: The ability to do assigned tasks on schedule under normal circumstances with a minimum of supervision. Unauthorized absence should be considered as it affects dependability.EXPLANATION _______________________________________________________________________________________________ SUGGESTIONS FOR IMPROVEMENT ABILITY TO DEAL WITH PEOPLE: Relationships with staff and the public; cooperativeness.EXPLANATION _______________________________________________________________________________________________ SUGGESTIONS FOR IMPROVEMENT SUPERVISORY ABILITY: (if applicable) The ability to delegate authority and accomplish assigned tasks through subordinates.EXPLANATION _______________________________________________________________________________________________ SUGGESTIONS FOR IMPROVEMENT RATED BY: SIGNATURETITLEDATELess Than Good service rating must include a recommendation regarding REVIEWED BY: SIGNATURETITLEDATEthe annual increment and should result in counseling of the employee.APPOINTING AUTHORITY OR AUTHORIZED REPRESENTTIVE:SIGNATURETITLEDATE  FORMCHECKBOX Award A.I.  FORMCHECKBOX  Deny A.I.EMPLOYEE: SIGNATURETITLEDATENOTE TO EMPLOYEE: Your signature confirms that you have seen this report and discussed it with your supervisor. .It does not indicate your agreement with or approval of the rating. The supervisor must give the employee a copy of the rating at the time the employee signs it. Should any subsequent change be made, all copies must be revised, and the change must be initialed by the employee. Page 1 GENERAL INSTRUCTIONS When To File A Service Rating A Service Rating Report is to be filed at the following times: During any working test period, either promotional or original, the quality of service of any employee shall be reported as either Good or Better for satisfactory or better performance and the form shall be on file in the office of the appointing authority not more than six nor less than two weeks prior to the termination of the period; or less than good performance, and the report shall be approved by the appointing authority and filed with the Commissioner of Administrative Services; an unsatisfactory service rating of an employee serving a working test period necessitates his/her release or demotion to a class in which he/she has prior status not later than upon termination of the working test period. When the performance of an employee with permanent status has been Less than Good; if the reviewer recommends precluding the annual salary increase, the report shall be approved by the appointing authority and filed with the Commissioner of Administrative Services prior to the employees increase date. When the appointing authority wishes to amend a previously submitted Fair or Less Than Good service report due to marked improvement in an employees performance, such report shall be filed with the Office of the Commissioner of the Department of Administrative Services not later than two weeks prior to the increase date, and it shall have precedence over previous reports and shall restore the annual increase. Annually for each permanent employee, said annual rating is to be filed in the office of the appointing authority at least three months prior to the employees annual increase date. At such other times as the appointing authority deems that the quality of service of an employee should be recorded. Preparing The Service Rating For the job factor Dependability, in considering abuse of attendance, the rater may consider absences exceeding the contractually earned leave days, except that he/she may also consider clearly identifiable pattern absences and/or repeated or extended unauthorized leave by an employee. All ratings are to be discussed with the employee by the employees immediate supervisor. The employee should be asked to sign the report, indicating that the employee has seen the form and discussed it with the immediate supervisor. The effective date of the rating shall be the date it is approved by the appointing authority. A copy of a Less than Good service rating is to be furnished to the employee, after having been approved. III. Consequences Of A Less than Good Service Rating A rating of Fair in two or more job factors constitutes an overall Less than Good service rating and may result in the employee being precluded from receiving the next annual salary increase. A rating of Unsatisfactory in one or more job factors constitutes an overall Less than Good service rating. If the employee receives a Less than Good service rating while on an initial or promotional working test period, the employee must be terminated or demoted, respectively, to a job class in which he/she held prior permanent status. If the employee receives a Less than Good rating and is not on a working test period, the Less than Good rating may preclude the employee from receiving an annual increase and shall preclude the employee from participating in Agency promotional merit system examinations. Two successive less than good service ratings, filed within a two year period, may result in the dismissal of the employee from State service. A review of any Less than Good service rating, other than those issued during any working test period, shall be done within sixty calendar days of the date of the original to determine whether improvement has been made and an amended service rating is in order. The effective date of any service rating shall be the date approved by the appointing authority. 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