Annual evaluation form foreign service




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U.S. Agency for International Development

ANNUAL EVALUATION FORM – FOREIGN SERVICE

EVALUATION PERIOD (mm/dd/yyyy)

FROM      

TO      

SECTION 1 – ADMINISTRATIVE DATA

a. NAME (Last, First, MI)

     


b. SSN (Last 4 digits)

    


c. RANK/STEP

     


d. POSITION AOSC TITLE

     


e. POSITION FUNCTIONAL TITLE

     


f. POST/USAID OFFICE

     


g. BACKSTOP

  


h. CAREER STATUS (Check appropriate box) - CAREER CANDIDATE  CAREER  OTHER 

SECTION 2 – AUTHENTICATION OF FINAL ANNUAL EVALUATION

a. NAME OF RATING OFFICIAL (Last, First, MI)

     


SIGNATURE


DATE


b. NAME OF AC CHAIRPERSON

     


SIGNATURE


DATE


c. EMPLOYEE: (Signature acknowledges receipt of evaluation, not necessarily concurrence with evaluation)

SIGNATURE
EMPLOYEE DECLINES TO SIGN 

DATE


SECTION 3 – FINAL ANNUAL EVALUATION PERFORMANCE RESULTS

a. EMPLOYEE MET ALL SKILL STANDARDS FOR HIS/HER CURRENT CLASS: YES  NO 

b. EMPLOYEE MET ALL WORK OBJECTIVES: YES  NO 

SECTION 4 – ROLE IN THE ORGANIZATION

Specify organizational setting, continuing responsibilities and functions within operating unit, including resources managed



     


For Official Use Only


Date Received by AMS/EXO                

Employee Statement Attached: YES  NO 

Date Received

by HR      



Date Placed in Official

Evaluation Folder      


AID 461-1 (04/04) Page 1 of 4



NAME (Last, First, MI)

     


SSN (Last 4 digits)

    


EVALUATION PERIOD (mm/dd/yyyy)

FROM      

TO      

SECTION 5 – PERFORMANCE PLAN

Establish Performance Plan within 45 calendar days of the beginning of the evaluation period

1 - 3 work objectives with 1 - 2 performance measures for each work objective


a. PERFORMANCE PLAN

     




SECTION 5b – AUTHENTICATION OF PERFORMANCE PLAN

c. NAME OF RATING OFFICIAL (Last, First, MI)

     


SIGNATURE


DATE


d. NAME OF AC REPRESENTATIVE (Optional)

     


SIGNATURE


DATE


e. EMPLOYEE: (Signature acknowledges receipt of performance plan, not necessarily concurrence with plan)

SIGNATURE
EMPLOYEE DECLINES TO SIGN 

DATE


SECTION 6 – FORMAL MID-POINT PROGRESS REVIEW

Includes any revisions to work objectives and performance measures



a. MID-POINT PROGRESS REVIEW

     




SECTION 6b – AUTHENTICATION OF FORMAL MID-POINT PROGRESS REVIEW

c. NAME OF RATING OFFICIAL (Last, First, MI)

     


SIGNATURE


DATE


d. NAME OF AC REPRESENTATIVE (Optional)

     


SIGNATURE


DATE


e. EMPLOYEE: (Signature acknowledges receipt of mid-point progress review, not necessarily concurrence with review)

SIGNATURE
EMPLOYEE DECLINES TO SIGN 

DATE

AID 461-1 (04/04) Page 2 of 4



NAME (Last, First, MI)

     


SSN (Last 4 digits)

    


EVALUATION PERIOD (mm/dd/yyyy)

FROM      

TO      

SECTION 7 – ASSESSMENT OF PERFORMANCE, SKILLS AND POTENTIAL

a. RATING OFFICIAL’S STATEMENT ON PERFORMANCE, SKILLS AND POTENTIAL (For more information, see the EEP Guidebook, Chapter V. Preparing & Completing the AEF)

     


AID 461-1 (04/04) Page 3 of 4



NAME (Last, First, MI)

     


SSN (Last 4 digits)

    


EVALUATION PERIOD (mm/dd/yyyy)

FROM      

TO      

SECTION 7 – ASSESSMENT OF PERFORMANCE, SKILLS AND POTENTIAL - CONTINUED

b. 360 INPUT SOURCES (Check all that apply):


EMPLOYEE’S SELF-ASSESSMENT CUSTOMERS MANAGERS PEERS SUBORDINATES AIF OTHERS
      

c. ADDITIONAL MANDATORY 360 INPUT SOURCES FOR THE FOLLOWING BACKSTOPS: CONTROLLERS, CONTRACT OFFICERS AND LEGAL ADVISORS - ONLY



RECEIVED 360 INPUT FROM USAID/W (Check as appropriate):

FINANCIAL MANAGEMENT PROCUREMENT GENERAL COUNSEL REQUESTED, BUT NOT RECEIVED

   


d. EVALUATION OF WORK OBJECTIVES:

WORK OBJECTIVE #1

MET  NOT MET 

WORK OBJECTIVE #2

MET  NOT MET  N/A 

WORK OBJECTIVE #3

MET  NOT MET  N/A 


SECTION 8 – APPRAISAL COMMITTEE MEMBERS AND COMMENTS

a. APPRAISAL COMMITTEE MEMBER NAMES (Last, First, MI):

1)      

2)      

3)      

b. APPRAISAL COMMITTEE COMMENTS (As appropriate):

     




Privacy Act Statement: The following statement is required to be attached to the subject form by the Privacy Act of 1974 (P.L. 93-579: 88 Statute 1896). This form is used to evaluate the performance of Foreign Service and Senior Foreign Service employees. Disclosure of information provided will not be made outside the Agency without written consent of the employee concerned except: (a) pursuant to any applicable routine use listed under USAID's Foreign Service Employee Personnel Records System (USAID 1) in USAID's Notice of System of Records (available from the Information and Records Division) for implementing the Privacy Act published in the Federal Register, or (b) when disclosure without the employee's consent is authorized by the Privacy Act and provided for in USAID Regulation 15. The Social Security Number is provided voluntarily by the individual to enable proper entry of this report into the employee's records. Failure to provide the required information could lead to mistaken identity entailing administrative complications with possible inconvenient or adverse consequences for the employee.
Confidentiality of Records: This form is an efficiency report which shall be subject to inspection only by those persons authorized by Section 604 of the Foreign Service Act, 22 U.S.C. 4004.

AID 461-1 (04/04) Page 4 of 4





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