1. Outstanding
.;
Competent
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County of Los Angeles Department of Public Social Services
Annual Performance Evaluation
GENERIC
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Employee Number 535486 litem Number 1138Employee Name DEREK FOLLEY
Position
INTERMEDIATE CLERK Period: From Jun 1, 2009 Through May 31,2010
Dept. Status IDue Date1Div. IP/L
PERM Jun 15, 2010140 746 H1
INSTRUCTIONS
1. Indicate on page 2, with the following symbols, whether the employee meets the Departmental Expectations (..J), exceeds it (+), or fails to meet it (-).
2. In the Comments section on the next page, indicate specifics of the employee's performance. Document by providing examples of above-average
or below-average work.
3. Enter the appropriate code in the box next to the Rating Factor:
o = Qutstanding VG =y'ery ~ood C =.Qompetent IN =improvement Needed U =!Jnsatisfactory
4. In the Overall Rating section below, check the appropriate rating.
5. Document employee's goals on the EMPLOYEE GOALS SHEET (Optional). See Customize Forms on PECS to retrieve this sheet.
6. Remember:
All overall ratings other than Competent must be supported by documentation.
DEFINITION OF RATING FACTORS
Use the following definitions of each rating to ensure that your rating factor is appropriate and sufficiently documented in the COMMENTS section on page 2.
OUTSTANDING: All work performance is consistently above the requirements of the position. A substantial part of the work performance exceeds super­
visory and management expectations most of the time. Factual evidence must be presented in writing to substantiate this rating.
VERY GOOD: A substantial part of the work performance is well above the expectations of performance required for the position and all other parts of the
performance are at least "competent". Factual evidence must be presented in writing to substantiate this rating.
COMPETENT: Work performance is consistently up to or somewhat above the requirements of the position. This is the performance expected of a trained
and qualified employee. NOTE: When an employee's performance tends to be borderline (high or low) within this category, a notation to this effect should
be made in the COMMENTS section.
IMPROVEMENT NEEDED: This rating indicates that (1) a significant part of the work performance is below the expectations of performance required for
the position and (2) it is reasonable to expect that the employee will bring performance up to acceptable standards. Factual evidence must be presented in
writing to substantiate this rating. .
UNSATISFACTORY: A substantial part of the work is inadequate and definitely inferior to the expectations of performance required for the position. Fac­
tual evidence must be presented in writing to substantiate this rating. When this rating is given it must be accompanied by a discharge or reduction in those
cases in which the employee is still in service.
Overall Rating for the Evaluation Period
Improvement Needed 1---­
I
II Unsatisfactory
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DATE /1'JlirJf.lfJEMPLOYEE ~ '!VCf1J
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Filing Instructions
PA 2121 (REV. 03/06) Page 1 of 4
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2. ')
Annual 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 his/her department's grievance procedure within ten business days of receipt of the evaluation.
He/She may grieve any specified item or items of the report, including the overall rating, except for an overallrat­
ing of "unsatisfactory." Upon completion of the grievance process, the Department Head or his/her 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 his/her evaluation. The request must be in writing and must include all
the facts and details upon which the employee's case is based.
~::I::ed9~ceiP't ?iii;eSignature~---,=---="",------,,~,-------,................ _
Date: /? <rUMS :Lara
I confirm the e
Rater ~
Signature: ..~ I
Date: -" f " , , I
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Page 2 of 4

3. -------------
County of Los Angeles Department of Public Social Services
Annual Performance Evaluation
GENERIC
Rating FacIo, 1
Departmental Expectations
~. . Productivity: VG
~[±]Amount of work performed
[±] Completion of work on schedule
2. Quality: VG
[±] Demonstrates accuracy and thoroughness
[±] Applies feedback to improve performance
[±] Edits and proofreads own work
[±] Writes clearly, concisely, and legibly
3. Work Habits: VG
[±] Observes organizational programs, policies, and
procedures
[±] Plans and organizes work
1Zl Attendance
o Observes working hours
[±] Sets appropriate priorities
[±] Shares knowledge with others
1Zl Complies with instructions
[±] Meets deadlines
4. Personal Relations: VG
[±] Represents the Department in a professional and
effective manner
[±] Practices cooperation and teamwork
IZJ Exhibits consideration in interactions with others
[±] Responds promptly to inquiries
[±] Exhibits appropriate personal appearance and
conduct
[±] Works effectively with all levels of staff
5. Adaptability: VG
[±] Adapts to changes in the work environment
[±] Performs effectively in new situations
[±] Performs effectively in emergencies
[±] Performs effectively with minimum instructions
6. Job Knowledge: VG
[l] Adheres to program policies and procedures
[±] Demonstrates required job skills
[±] Understands relevant computer systems
[±] Makes appropriate use of training resources
o Ability to diagnose and evaluate problems (if applicable)
o Has appropriate interviewing skills (if applicable)
o Ability to develop appropriate service plan (if applicable)
. Jun 15,2010
Employee Number 535486
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 rating period, Mr. Derek Folley
continued his assignment as an Intermediate
Clerk at the Hawthorne Medi-Cal Sub-Office
District #93.
His primary duty was Mail Room Operations.
He processed all outgoing and incoming
mail for the District, including: pick-up,
weighing, metering, opening, date stamping,
and distribution to appropriate Eligibility
Staff. Mr. Folley assisted with (COC)
process, Case Opening Clerk, our 1/800
phone lines, Suspense Desk, Stock Room,
and was a great help assisting Eligibility
Staff with indexing. In the absence of his
supervisor, Mr. Folley assisted with the
DAR'S.
PRODUCTIVITY:
Mr. Folley met the standards for processing
all work assignments. He performed and
completed an adequate amount of work
accurately and timely. He ensured that all
outgoing mail had appropriate postage for
delivery.
QUALITY:
Mr. Folley was thorough and took time to
proofread his product to demonstrate
accuracy. He manually wrote up a
tremendous amount of Suspense Cases
clearly and legibly to be stored with FKI, File
Keepers. He's an efficient worker, and
displayed the ability to multi-task.
PA 2121 (REV. 03/06) Page 3 of4
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4. County of Los Angeles Department of Public Social Services
Annual Performance Evaluation
GENERIC
Date: Jun 15. 2010Ratina Period: From Jun 1. 2009
Employee Name DEREK FOLLEY 535486
Rating Factor
Departmental Expectations JI~.-· Communication Skills: vo
L.ffi Provides prompt and courteous customer
service
ffi Maintains open lines of communication with all
levels of staff and community
[l] 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.
WORK HABITS:
Mr. Folley observed programs, policies, and
procedures. He met the Departmental
standards for attendance. He complied with
instructions, shared knowledge with other
subordinates, and he set appropriate
priorities in order to complete his work
product in a timely manner. Mr. Folley can
be counted upon to assist as needed.
PERSONAL RELATIONS:
Mr. Folley represented the Department in a
professional and effective manner. He
displayed a positive attitude towards all
levels of staff. Mr. Folley practiced
cooperation and is a Team Player. When
needed atthe 1/800 phone lines, he did not
hesitate to accept the challenge servicing
over 5,000 callers. Mr. Folley showed strong
desire to assist within the clerical functions.
He always offered his assistance.
Mr. Folley also exhibited appropriate
personal appearance and conduct.
ADAPTABILITY:
Mr. Folley performs effectively in the
workplace with minimum instructions. He
showed the ability to perform in an emergent
and new situations. Stock supplies was
delivered to the District, contact employee
wasn't available, he ensured all supplies
received was calculated and signed off.
Mr. Folley adapted to change in the work
environment. He had the opportunity to
transfer back to Hawthorne Regional District
#92 as of 03/2010.
PA 2121 (REV. 03/06) Page 4 of 4
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5. ) )
County of Los Angeles
Performance Evaluation
(Supplemental Sheet)
Annual
Department of Public Social Services
TYPE OF PERFORMANCE EVALUATION
EMPLOYEE NAME:
DEREK FOLLEY
POSITION:
INTERMEDIATE CLERK
EMPLOYEE NUMBER:
535486
DEPT.
140
DIV.
746
SUB
H1
DUE DATE:ITEM NUMBER:
Jun 15,20101138
RATING PERIOD
From: Jun 1, 2009 Through: May 31, 2010
JOB KNOWLEDGE:
Mr. Folley demonstrated the required skills to perform his daily task effectively. He utilized the
computer system, and LEADER daily to enhance knowledge gained to perform his duty.
Assisting (COC) Case opening, and the clearance process of daily mail. On May 17, 2010, Mr.
Folley attended eCAPS supply inventory training, Mr. Folley made appropriate use of training
resources, Exams, and has a strong desire to promote.
COMMUNICATION SKILLS:
Mr. Folley provided prompt and courteous customer service. He ensured all incoming and
outgoing mail was processed and distributed in a timely manner. He maintained open lines of
communication with staff and community. Mr. Folley serviced customer calls in a professional
and effective demeanor. He's a respectful and great employee to have worked with.
Mr. Derek Folley is a dependable employee of the Department; Therefore, I'm pleased to rate his
performance as "VERY GOOD" for this rating period.
C36) DATE:
DATE:
DATE:
,..
PA 223 (REV. 03/06)