SAN JOSE-EVERGREEN COMMUNITY COLLEGE

MSC SUPERVISOR - PERFORMANCE EVALUATION FORM

Employee Name Job Title Evaluation Date

Supervisor’s Name Supervisor’s Title Due Date

PERFORMANCE AREAS
Key Job Responsibilities
In order of priority, list the top 3 to 5 job responsibilities of this position or attach the current job description.
1.
2.
3.
4.
5.

PERFOMANCE SUCCESS FACTORS

Instructions: Identify the Success Factors which are relevant to the job. If a factor is not applicable to the job,
please indicate by recording “N/A”.

List additional Success Factors that are important but are not listed below; list and define additional behaviors in
the space designated “Other”.

Assess each relevant factor, specifying both areas of strength and, if applicable, areas for improvement.
Supervisory/Professional Performance Success Factors - Review/Evaluation
1. Planning & Organizing: Establishes courses of action for Review/Evaluation
oneself and/or others that are efficient and effective in
meeting short- and long-term goals.

2. Manages Execution: Assigns responsibilities; delegates Review/Evaluation

and empowers others to accomplish assignments; when
necessary, coordinates work efforts; monitors progress; gets
things done.
3. Judgement & Decisiveness: Makes timely and sound Review/Evaluation
decisions based upon analysis which reflect
factual information; understands the short- and long-term
consequences when making decisions.
4. Quality-of-Service: Makes effort to listen to Review/Evaluation
and understand internal/external audiences, anticipates their
needs and gives top priority to their satisfaction; displays
sensitivity to their sense of urgency.
5. Performance Planning & Management: Provides clear Review/Evaluation
direction and priorities; consistently measures results; gives
timely feedback and helpful coaching. Carries out discipline
when needed.
6. Sensitivity to Others: Demonstrates sensitivity and Review/Evaluation
awareness to the diversity (cultural, racial, social and
economic) of students, staff, faculty, management and the
community to ensure the area is responsive to the needs of
those served.

7. Team Leadership: Accomplishes tasks leading and Review/Evaluation

working with others, builds effective teams committed to
organization goals; fosters collaboration among team
members and among teams.
8. Initiative: Sets high goals/standards of performance for Review/Evaluation
self and/or others; actively attempts to influence events;
takes action beyond explicit job responsibilities.

9. Oral/Written Communications: Effectively gives and Review/Evaluation

receives information; clearly presents ideas/tasks to
groups/individuals;actively listens to others demonstrating
attention to and understanding of expressed comments and
concerns.
10. Job Knowledge: Masters required knowledge to carry Review/Evaluation
out duties
11. Technical Expertise: Demonstrates the technical skills Review/Evaluation
required by the positon and maintains currency in the field.
12. Other (Please Define) Review/Evaluation

YEAR –END ANNUAL GOAL EVALUATION

Using the following standards, please evaluate the prior annual goal statements this is a year-end evaluation. Note
accomplishments, goal modification, areas for improvement. Select the description that most closely identifies the overall
performance.

_____ Exceeds Expectation: Performance and results frequently exceeded the position’s requirements and
expectations. All planned goals were achieved above established standards. The performance behavior was
consistent with the selected Critical Success Factors. The contributions made improved the effectiveness of
the department or unit.
_____ Achieves Expectations: Performance and results met all position requirements and expectations.
Planned goals were achieved within acceptable standards. There may have been some accomplishments
which exceeded expectations and some areas where results did not fully meet expectations. Similarly, the
performance behavior is generally consistent with the selected Critical Success Factors. On balance, this is a
good performer.
_____ Needs Improvement: Performance and results met some, but not all the position’s requirements and
expectations. The need for further development and/or improvement is recognizable. The performance
behavior demonstrated is occasionally consistent with the selected Critical Success Factors. Sustained
progress and improvement are required.
_____ Unacceptable: Performance and results are not acceptable. The position’s requirements and
expectations have not been met. Performance must improve to an acceptable level or additional corrective
action will be taken, up to and including possible discharge.

Goal Statement Standard Meet

Goal Statement #1 Exceeded Expectations
1.
Goal Statement #2
1.
Goal Statement #3
1.
Goal Statement #4
Goal Statement #5
 PROSPECTIVE ANNUAL GOAL STATEMENTS/ MID-YEAR REVIEW & FEEDBACK
List 3 to 5 key goals to be accomplished -- short statements of expectation. Conduct mid-year review of progress;
Goal Statement #1 Mid-Year Review

___ On-Track

___ Needs Attention

Feedback

Goal Statement #2 Mid-Year Review

__ On-Track

___ Needs Attention

Feedback

Goal Statement #3 Mid-Year Review

___ On-Track

___ Needs Attention

Goal Statement #4 Mid-Year Review

.
___ On-Track

___ Needs Attention

Goal Statement #5 Mid-Year Review

__ On-Track

___ Needs Attention

 OVERALL PERFORMANCE EVALUATION
Consider what has been accomplished and how job responsibilities were accomplished. Summarize
performance results below.

INDIVIDUAL IMPROVEMENT PLAN

Establish plans, with time frames for accomplishment, designed to develop and improve skills. Development
activities may include formalized training, seminars, on-the-job assignments, self-development, etc. Be certain
to take into consideration areas of demonstrated strengths and areas for improvement (Overall Performance)
when developing this plan.

Development Plan:

Employee Comments:
Certifications:

San Jose-Evergreen Community College District expects all employees to perform their job responsibilities in a safe and
ethical manner, in compliance with federal and state regulations and District Board policies, and demonstrate sensitivity,
knowledge, and understanding of the diverse academic, socioeconomic, gender, gender identity, cultural, disability, and ethnic
backgrounds of the students we serve .

Mandatory Trainings:
__Sexual Harassment (Every 2 years)
__Mandatory Reporter of Child Abuse (Annual)
__Responsible Person (Title IX) (Annual)
__Injury Illness Prevention Plan (IIPP)

Please check this box to signify that the supervising administrator and supervisor have discussed compliance with
these standards along with compliance with other standards that may be specific to the department/area.

ACKNOWLEGEMENTS
EMPLOYEE SIGNATURE: DATE:

SUPERVISING ADMINISTRATOR SIGNATURE: DATE:

RECEIVED BY PERSONNEL: DATE:

(EMPLOYEE’S SIGNATURE DOES NOT NECESSARILY CONSTITUTE AGREEMENT WITH THIS EVALUATION)