Probationary Evaluation

EMPLOYEE'S FIRST NAME

EMPLOYEE'S LAST NAME

CLASSIFICATION

COUNTY AGENCY

This form should be completed at the end of the fifth month. A formal evaluation of the employee's performance should be conducted at least twice during the probationary period at the end of the third month of the probationary period and again at the end of the fifth month.

A copy of the employee's performance evaluation may be attached to this form.

Summary evaluation of the employee

On the basis of the performance evaluation of this employee, the employee's development is best described by the following statement:

Present level of performance and rate of development is fully satisfactory.

Generally adequate level of development but needs special emphasis in one or two areas of performance.

Must make more rapid progress if satisfactory level of performance is to be attained during the probationary period.

Performance and rate of development is unsatisfactory.

Did the probationary evaluation result in an extension of the probationary period?

Yes

The letter notifying the employee of the extension must be attached to this form. [See Merit System Rules, part 9575.0740]

SUPERVISOR'S COMMENTS

Supervisor

By checking this box and typing my name in the "Electronic Signature" field, I understand that I am electronically signing this form. In addition, I attest and certify that the information provided above is true and accurate. I understand that my electronic signature has the same legal effect and can be enforced in the same way as a handwritten signature. (MN Stat. §325L.07)

SUPERVISOR'S ELECTRONIC SIGNATURE

DATE

Send a confirmation and copy of this form to the submitter

Enter an email address below and a confirmation, including a PDF file of the information provided, will be sent

Send a confirmation and copy of this form to the director

Enter an email address below and a confirmation, including a PDF file of the information provided, will be sent to the director

Does employee need to review and sign this form?

Yes

EMPLOYEE'S EMAIL ADDRESS

Does agency director need to review and sign this form?

Yes

AGENCY DIRECTOR'S EMAIL ADDRESS

Employee

I certify that I have seen this form as completed. (Signature does not mean that you agree with the employer's ratings or comments. Any disagreement or comments may be noted below.) By checking this box and typing my name in the "Electronic Signature" field, I understand that I am electronically signing this form. In addition, I attest and certify that the information provided above is true and accurate. I understand that my electronic signature has the same legal effect and can be enforced in the same way as a handwritten signature. (MN Stat. §325L.07)

EMPLOYEE'S ELECTRONIC SIGNATURE

DATE

EMPLOYEE COMMENTS

Agency Director

AGENCY DIRECTOR'S ELECTRONIC SIGNATURE

DATE

GUIDEmployee

GUIDDirector

DHS Use Only

DHS ACTION

APPROVED BY

APPLICATION ID

POSITION NUMBER

CLASS CODE

Form State Cd

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