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Employee Name:
Job Title:
Social Security Number: Date:
Please fill out the remainder of this form with your honest assessment of your job performance in
the past twelve months to the best of your ability. The information on this form will be used in
your performance appraisal and in judging your job performance. Return this form one week
prior to your evaluation meeting with your direct supervisor to allow time for preparation for the
performance appraisal meeting. Feel free to attach additional pages if necessary.
1. If you were to write a description of your on-the job duties, what would be the top three
2. What do you feel have been your greatest achievements in the past year? How did you go
about creating these successes for yourself?
3. What were the greatest weaknesses in your job performance in the past year? How did
you act to minimize these weaknesses?
4. What do you think your strongest collaborative efforts over the past year were? Give an
Self Evaluation Form
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