SAMPLE Employee Self-Appraisal Form
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SCHOOL OF MEDICINE
Employee Self-Appraisal Form
NAME ______________________________________________
JOB TITLE __________________________________________
DEPARTMENT _______________________________________
DATE _______________________________________________
Please take some time to respond to the following questions/requests and return to your supervisor by _______________________so that your comments can be taken into consideration when completing the annual performance appraisal form. If you have any questions about the self-appraisal process, please discuss them with your supervisor.
1. List and describe your achievements and successes during the past year.
2. List and describe any job challenges you experienced in accomplishing your goals. Include why they were difficult and what may have caused the difficulty. Be specific. Also, list what assistance/resources/mentoring might help you in getting these goals accomplished.
3. What training or development do you think would a) help you in performing your current job, or b) help you to develop in your career?
4. What specific performance and career development goals can you set for the coming year to further
enhance your contributions to the Department? (See SMART Goals reference at )
6. What can your supervisor do to assist you in performing your job duties to the best of your abilities?
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