Student:

Company:

SSN:

Supervisor:

Course:

Address:

Term:

Telephone:

Supervisor Signature:

Instructor to Evaluator: Read each of the four factor definitions and assign a numerical value ranging from 1 (low) to 25 (high) that describes the employee's/intern's job performance. Comments are optional and should be appropriate to the factor being evaluated. The completed form should be mailed to student's/intern's instructor in the stamped/addressed envelope provided.

1.

Knowledge of Work/Competence: Consider how well the employee/ intern understood or learned work assignments and how well the employee/intern performed the assignments once shown. Neatness, accuracy and effectiveness are all factors included in this rating.

Comments:

Rating [____] (1-25)

2.

Dependability/Work Ethic: Consider how well the employee/intern adhered to assigned work schedule and how well the student adhered to his/her assigned tasks while on the job. Attendance shall be included in this rating, as will the employee/intern reporting, in advance, that he/she would be late or not able to report on a given day.

Comments:

Rating [____] (1-25)

3.

Judgement/Initiative: Consider the employee/intern's ability to plan, set priorities, and make logical and sound decisions. Consider as well the employee/intern's ability to see what needed to be done and proceed to do it without being asked or directed.

Comments:

Rating [____] (1-25)

4.

Interpersonal/Communications Skills: Consider the employee/intern's ability to work with others and promote a sense of cooperative/team effort. Consider as well the employee/intern's ability to communicate effectively, and in a timely fashion, with other employees including his/her supervisor.

Comments:

Rating [____] (1-25)

TOTAL [____] (1-100)