1. County of Los Angeles Department of Public SocIal Services
Performance Evaluation
I••IIIIIBIIIIIPROBATIONARY
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ilEmployee Name ~EREKFOLLEY Employee Number 535486 lem Number 1138 '
, Position INTERMEDIATE CLERK Period: From Oct 1, 2008 Through Mar 31.2009
Dep!. -~' IOiv,-- 737 PIL H1 Slatus PERM Due Date Feb 28,2009
INSTRUCTIONS
1, Indicate OIl Page 2, wlIh the following symbols, whether the employee meets the Departmental elCpllctalion (V), OKCeeds i( (+), or falls 10 meelll (-).
2. In the Comments lleclion an the next page, indicale specifICS ollhe employee's performance. Document by providing examples of above-3verage or
below-aVtlfDge wot1l.
3. Enler lhe appropriate code In the box next 10 the Rating Factor:
IN =Improvement /l!eeded C '" ~mpelant U '" Unsatisfactory
4. In the aver.tI RatIng section below, check the appropriale fEting.
Documenl employee's goals on lhe EMPLOYEE GOALS SHEET (OptionaQ. See Cuslomize Forms on PEeS to retrieve this sheet.
!'Is,6, Remember:
I AU overall ratings other 1han Competent musl be suppor1e<l by documenlallon.
II DEFINmON OF RATING FACTORS. II!
Use 'he folIawing definitions ofeach raUng /0 enSUf8 that yourrating fsctor is appropriate Bfld suffICientI)' doaJmented In ltle COMMENTS section on pagfl 2. I'
I IMPROVEMENT NEEDED: The probationer is nol progl'e$ing allt fEle commensurate with hisll1er Ume. lfSining and experience on the job. If heIshe does
: nol actJieve speclfic goals by the Ome specltled in the report. he/she wi. nol pllS6 probation. .
i COMPETENT: WorI peIfomance Is llquallo or a~ove the reqLJiremenls of the position. This rating carries wrth it the appointing authoritys approval to make
Ithe appoin1ment fmal and complete.
I UNSATlSFACTORY: The employee's performance is below performance requirements for the position. Factual evidence must be presenled in writing 10
Iwbstanliate hi$ raling, wIlIcII carries with it the appointing aulhorlly's df1c:I&ion nol to awOVCl final and complete appoinlment If permanenl employmenl
. recommended, no factOl" should be assigned lhls rallng.
OVERALL RATING FOR EVALUATION PERIOD RECOMMENDATION TO DEPARTMENT HEAD
III ldo
Rec:ommelld~ complele appointment /<o IMPROVEMENT NEEDED-INTERIM ONLY
o Idonol IIZl COMPETENT
RATER'S SIGNATURE OAT'?' ~ ()
o UNSATISFACTORY IlJ ldo
'I Recommend the proballoner's !ina
o ldonol
I REVIEWER'S SIGNATURE_DAT~~ I.
.rACnON OF DEPARTMENT HEAD IUSE WHEN PROBATIONARY PERIOD NOT COMPLETE 1
'I'concur wit", and approve his report of pelfotmSnce evaluation,
; On the basis of thiS report:
IZJ I approve final appointmenl.
o I do not approve final appoinllllent. and requesl the commission's
oonsentto:
o
DATE _o Failed medical exemlnation
OATE _o Resigned from County service
o left position 10 accept another
DATE _County position
o DATE _Copy of report to employee:
~1Ied
DATErWf· V. lZ'L'V I
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I Personnel FOlder: One Copy to Office Personnel Folder; One Copy to Employee.
~ntralPersonnel Folder; One Copy 10 CAO; One Copy 10 Office Personnel Fokler. One Copy 10 Employee.
PA 2118 (Re1I 03lO6) P_'013
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2. Performance Evaluation
APPEAL PROCEDURE
If the employee disagrees with the ratings given and is still in County service, he/she may initiate a grievance in
accordance with hislher department's grievance procedure within ten business days of receipt of the evaluation.
HefShe may grieve any specified item or items of the report, including the overall rating, except for an overall rat­
ing of 'unsatisfactory: Upon completion of the grievance process, the Department Head or hislher representative
must approve the report and rating as originally prepared, or direct that a new report be prepared and notify the
employee of the decision.
Out of Service Employees
If subsequent to his/her resignation from County service an employee receives an evaluation with an overall rat­
ing of "Improvement Needed" or "Unsatisfactory," he/she may request reconsideration of this rating by the Direc­
tor of Personnel. The request for reconsideration must be received in the Office of the Director of Personnel
within ten business days after receipt of hisfher evaluation. The request must be in writing and must include all
the facts and details upon which the employee's case is based.
..............-_ __ __ __ _ --·····..··'r···
I ackrowledge receipt of a copy is pag . II. I confirm the emp~oY.:. ceipt of a copy of this page.'
Employee IJ I
S;gn,lu,", AA'lAQA.....
D,le J.r; Pce. at
I: Rater
dSign"u,",
IIDale
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d-~ 0Cj
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3. County of Los Angeles Department of Public Social Services
Performance Evaluation
PROBATIONARY
DEREK FOLLEY
Through Mar 31,2009
Rating Factor
j[De~rtm.n",Expectation,
1. Productivity: _ w[±] Amount of work performed
[±] Completion of work on schedule
2. Quality: ljiJ
[±] Demonstrates accuracy and thoroughness
ill Applies feedback to improve performance
[{] Edits and proofreads own work
ill Writes clearly, concisely, and legibly
3. Work Habits: I c I
[±] ObselVes organizational programs, policies, and
procedures
III Plans and organizes work
[±] Meets attendance requirements
!ll Observes working hours
[±] Sets appropriate priorities
[±] Shares knowledge with others
III Complies with instructions
III Meets deadlines
4. Personal Relations: ______ Ccl
[±] Represents the Department in a professional and
effective manner
[±] Practices cooperation and teamwork
III EXhibits consideration in interactions with others
!ll Responds promptly to inquiries
III Exhibits appropriate personal appearance and
conduct
[±] Works effectively with all levels of staff
5. Adaptability: l£j
[±] Adapts to ch&nges in the work environment
[±] Performs effectively in new situations
GJ Performs effectIvely in emergencies
[±] Performs effectively with minimum instructions
Ie:6. Job Knowledge: _ ~.,
IZI Adheres to program policies and procedures
II] Demonstrates required job skills
III Understands relevant computer systems
III Makes appropriate use of training resources
7. Communication Skills: ! c!
[±] Provides prompt and courteous customer service
[±] Maintains open lines of communication with all
levels of staff and community
III Is able to impart negative information in a
courteous and respectful manner
COMMENTS (Required)
Discuss the employee's performance, giving examples to support
your ratings. If he/she has functioned in an Acting position during
the rating period, please discuss his/her performance in that
capacity. Attach extra pages if needed.
During this evaluation period, Mr. Fol/ey served
as an Intermediate Clerk at the Hawthorne
Medi-Cal Regional Sub-Office District #93, under
the supervision of Mr. Oscar Fuentes and this
rater. Mr. Fuentes was contacted and concurs
with the evaluation comments.
The primary duties of Mr. Folley was to provide
assistance with phone coverage for units 106
and 107, update the dispositions of each
Medi-Cal case, and maintain the master control
log on the LEADER computer system. Mr. Folley
was responsible for ordering supplies and
preparing cases for processing, either to the
Suspense and/or Active Historical section. He
also ensured that the eligibility workers received
their appropriate case documents in a timely
manner.
PRODUCTIVITY/QUALITY:
Mr. Folley was an efficient worker and displayed
the ability to multi-task a sufficient amount of
work. His computer skills are extensive and
readily accessed upon request. Mr. Folley
performed a more complex clerical and highly
specialized work of the unit by creating
spreadsheets for monthly reports.
WORK HABITS/PERSONAL RELATIONS:
Mr. Folley demonstrated good organization skills
and a the ability to be a team player. He
provided clerical assistance for two units without
"skipping a beat". He was congenial and
professional with aI/levels of staff. Mr. Folley
arrived at his work station on time and was ready
to tackle whatever tasks came his way.
PA 2118 (Rev. 03/06) Pa!i" 3 of 3
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4. - - - -
EMPLOYEE:
RATER:
REVIEWER:
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County of Los Angeles Department of Public Social Services
Performance Evaluation
(Supplemental Sheet)
Probationary
TYPE OF PERFORMANCE EVALUATION
Mr. Folley understood that in an ever-changing work atmosphere, it is essential to remain as flexible as
possible. He did not hesitate to accept assignments that challenged his abilities. He welcomed the
opportunity to develop new skills-sets by creating duty schedules for both units on a monthly basis, and
strived for excellence while adhering to Departmental polices. Mr. Folley frequently provided coverage
for the Administrative Secretary during breaks by answering the phone lines upon request.
COMMUNICATION SKILLS:
Mr. Folley exceeded expectations in regards to his communication abilities. His writing and verbal skills
were concise and clear. He is capable of communicating with our clientele in a respectful manner. Mr.
Folley was able to convey sensitive information that is understood and factual.
During this rating period, Mr. Folley attended the following training:
Clerical Training - D.P.S.S. Academy, Jan. 2009
SABA Security Awareness:
Module 1 - Fundamentals, Module 2 - Correspondence, Module 3 - Transactions.
SIGNATURES:
DATE:;2 .-,7-L< - CJ (
DATE: d- ~~, __ ()
EMPLOYEE NAME:
DEREK FOLLEY
EMPLOYEE NUMBER:
535486
POSITION:
INTERMEDIATE CLERK
DEPT.
140
DIV.
737
PIL
H1
ADAPTABILITY/JOB KNOWLEDGE:
ITEM NUMBER: DUE DATE:
1138 Feb 28.2009
RATING PERIOD
From: Oct 1, 2008 Through: Mar 31, 2009
PA 223 (Rev 03106)
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5. ---­
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County of Los Angeles
Performance Evaluation
(Supplemental Sheet)
Probationary
Department of Public Social Services
TYPE OF PERFORMANCE EVALUATION
EMPLOYEE NAME'
DEREK FOLLEY
POSITION:
INTERMEDIATE CLERK
EMPLOYEE NUMBER:
535486
DEPT,
140
DIV.
737
Pit.
H1
SUMMARY:
ITEM NUMBER: DUE DATE:
1138 Feb 28,2009
RATING PERIOD
From: Oct 1, 2008 Through: Mar 31, 2009
Mr. Folley can be counted upon to be at his work station promptly and ready to assist all levels of staff
without hesitation. He continued to adapt to the pace of an Approved Medi-Cal Only unit. He was
dedicated and possessed strong work ethics. He maintained a positive and professional attitude in
displaying a readiness to address clerical concerns of his unit members and his supervisors.
Mr. Folley's overall performance for this rating period is "Competent." I recommend the probationer for
final appointment.
SIGNATURES:
RATER'
REVIEWER:
DEPARTMENT HEAD: .P
DATE: ;L ---~ (
DATE:
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-0 I'
PA 223 (Rev. 03106)
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