The Personnel Board of Jefferson County Alabama

7 Digit Employee ID or Last 4 of SSN
Employee Name
Class Title
Merit Increase Date
(must be within + - 8 daysof the anniversary date) N/A if not applicable)
Period applicable to this appraisal from to

How To Use This Form

Step 1: Supervisor (Rater) completes task statement review (see page 2 of this form).
Step 2: Rater reviews performance appraisal with higher level management official. Rater and management official sign Box #1 following review.
Step 3: Rater reviews performance appraisal with employee. Employee signs Box #2 reflecting agreement/disagreement.
Step 4: Return form to Personnel Board of Jefferson County 2121 8th Avenue North Suite 100; Birmingham, AL 35203

Review Acknowledgement

This employee received a total of marks in the "Below Expectations
Management Approvals
Rater Signature
Rating Date
Rater (Print Name Here)
Rater's Phone #
Rater's Email Address
Rater's Employee ID#
Management Official's Signature
Employee Acknowledgement
My supervisor has reviewed this appraisal with me and:

(You may attach supporting documents)