Kern County EPR

EMPLOYEE PERFORMANCE REPORT
COUNTY OF KERN PERSONNEL DEPARTMENT
DEPT. NO.
l
DEPARTMENT NAME CLASSIFICATION
I
EMPLOYEE NAME EMPLOYEE NO.
1130 AIMIIOr APPRAISER 1 NASE DANIEL RAYMOND 999.02-5531
REASON FOR RATING RA.TU 1r- "''1n
3-MONTH REVIEW
D D FROM TO
YEsD NODIF 6-MONTH PROBATIONARY, DO YOU RECOMMENO PERMANENT APPOINTMENT? 7/5/2011 9/24/2011
SPECIAL SEPARATION
SECTION A - ITEMIZED CHECK LIST SECTION B - OVERALL PERFORMANCE
~
> CHECK OVERALL EVALUATION WHICH MUST BE CONSISTENT WITH THE ITEMIZED
EMPLOYEE'S IMMEDIATE SUPERVISOR SHOULD CZ: RATINGS. ALTHOUGH THERE IS NO PRESCRIBED FORMULA FOR COMPUTING THE
CHECK EACH ITEM IN THE APPROPRIATE COLUMN.
t (!)
i e OVERALL PERFORMANCE, ~ WRITTEN COMMENTS AAE REQUIRED TO JUSTIFY
REPORT MUST BE COMPLETED IN INK. ANY ~
~ ~ OUTSTANDING OR UNSATISFACTORY RATINGS.
CHANGES MADE IN THE REPORT SUBSEQUENT TO
b i
IITHE EMPLOYEE'S SIGNING REQUIRE INITIALING BY
~ ~o
~ D D ~ D D
THE EMPLOYEE ANO PERSON MAKING THE z
CHANGES
Cl)
§~~ ! t¥:~
8 l~ z OIJT8T...m>ING ABOVE STANOARC) IMPRO'IIEMeNT UliBAnSFACTDRY
Cl) :::, STAlie>ARD NEEDfC)
ALL EMPLOYEES: COMMENTS:
, ATTENDANCE X This is your three month review, Daniel, halfway through your probationary period.
2 PUNCTUALITY X Over the last three months, you've learned to measure and sketch new houses and
3 PHYSICAL FrrNESS X enter the information in our database. You've learned to process deeds and to
4 PERSONAL NEATNESS X
value property using comparable sales. You are taking Course 1, and keeping up
with the aasignened reading and exams.
5 COMPLIANCE wrrH RULES ANO Rl,GULATIONS X
S COOPERATION X For the most part, you've caught on fast. I appreciate your thoroughness and
7 ACCEPTANCE OF NEW IDEAS ANO PROCEDURES X
dedication to getting things rignt. You have experienced some difficulties
processing deeds. but overall your work appears satisfactory.
8 SAFETY PRACTICES X
9 APPLICATION OF EFFORT X When proce1Sing deeds, remember that we are looking for information that the
,o INTEREST IN JOB X typical buyer would consider important when making a real estate purchase.
Location, size, age and amenities are all important, but don't hightlight or disqualify
11 ACCURACY OF WORK X sales for similarities or differences which are unlikely to be recognized in the
12 QUALITY OF JUDGMENT X market. (For instance: one or two years age difference In a forty year old house, or
1:l PUBLIC RELATIONS X a lot size variation which amounts to a few hundred square feet)
14 ~ITTEN EXPRESSION X Keep up the hard work, Daniel. I believe you will make great progress In the next
15 ORAL EXPRESSION X three months.
,s EQUIPMENT OPERATION X
17 NEATNESS OF WORK X
18 PERFORMANCE WITH MINIMUM SUPERVISION X
19 PROMPTNESS IN COMPLETING WORK X
20 VOLUME OF WORK PRODUCED X
21 PERFORMANCE UNDER PRESSURE X
22 PERFORMANCE IN NEW WORK Srrl.JATIONS X
23 CUSTOMER SERVICE EMPLOYEE'S CERTIFICATION:
GREETINGS X
QUALITY OF SERVICE X
[RIHELPFUL.NESS X
I HEREBY CERTIFY I HAVE REVIEWED THIS REPORT.
KNOWI.EOGE X
D I REQUEST AN APPOINTMENT TO DISCUSS THIS RATING WITH MY
RESPONSIVENESS X
DEPARTMENT HEAD.
EMPLOYEH WHO SUPl!RVISE:
~•-••~~• X ~ f f , / ~ j )I COORDINATING WORK WITH OTHERS
? ACCEPTANCE OF RESPONSIBILITY (I UNDER6'TAND MY SIClNATURE DOES NOT N!CESIIARILY Ml!AN I AGRE! Wln-t AU. THE MARl<INGII) f
I ESTABLISHMENT OF WORK STANDARDS
iw;I TRAINING ANO LEADING STAFF
x ~
sl11J/If
: PLANNING AHO ASSIGNING WORK
-- C)ATfRATER'S SIGNATURE
~
FAIRNESS AHO IMPARTIALITY TO STAFF
CONTROL OF STAFF PRINTED liA~ITU: Jon Lifguist/Sueervising Aeeraiser
ADEQUACY OF INSTRUCTION&
~q__-~1-1/
ADDITIONAL ITU&:
FIEl/ll!'M:R'& SIGNATURE
""'°eROOATIOHARY ""00 ~
EMPLOYEE OFF WITHOUT PAY YES' ~ NO • . PRJNTEO NAME/TIT~
IF YES, TOTAL. HUMBER OF DAYS wrrHOUT PAY : • r'. ~
r
~(f' 111
copy • PERSONNEL 2"" copy • DEPARTMENT 3'4copy • EMPLOYEE
:VISED 11110

DEPT. NO. f
1130
DEPARTMENT NAME
AsaeHor
REASON FOR RATING
&·MONTH REVIEW, ELIG. FOR PERM. APPT.
Cl.ASSIFICATION
APPRAISER 1 I
D
EMPLOYEE NAME
NASE DANIEL RAYMOND
D FROM
I
EMPLOYEE NO.
999-02-5538
·~ ..
TO
IF &-MONTH PROBATIONARY, DO YOU RECOMMEND PERMANENT APPOINTMENT7 YES~ NOD 7/7/2011 12/31/2011
SECTION A - ITEMIZED CHECK LIST
1
2
EMPLOYEE'S IMMEDIATE SUPERVISOR SHOULD
CHECK EACH ITEM IN THE APPROPRIATE COLUMN
REPORT MUST BE COMPLETED IN INK. ANY
CHANGES MADE IN THE REPORT SUBSEQUENT TO
THE EMPLOYEE'S SIGNING REQUIRE INITIALING BY
THE EMPLOYEE ANO PERSON MAKING THE
CHANGES.
ALL EMPLOYEH:
ATTENDANCE
PUNCTUALITY
3 PHYSICAL FITNESS
4 PERSONAL NEATNESS
5 COMPLIANCE WITH RULES ANO REGULATIONS
6 COOPERATION
7 ACCEPTANCE OF NEW IDEAS AND PROCEDURES
8 SAFETY PRACTICES
9 APPLICATION OF EFFORT
10 INTEREST IN JOB
11 ACCURACY OF WORK
12 QUALITY OF JUDGMENT
13 PUBLIC RELATIONS
1, WRITTEN EXPRESSION
15 ORAL EXPRESSION
16 EQUIPMENT OPERATION
17 NEATNESS OF WORK
16 PERFORMANCE WITH MINIMUM SUPERVISION
19 PROMPTNESS IN COMPLETING WORK
20 VOLUME OF WORK PRDOUCEO
21 PERFORMANCE UNDER PRESSURE
22 PERFORMANCE IN NEW WORK SITUATIONS
23 CUSTOMER SERVICE
GREETINGS
QUALITY OF SERVICE
HELPFULNESS
ICNOWLEDGE
RESPONSIVENESS
!MPLOYEEIWHO 8UPEltVl8E:
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
SPECIAL SEPARATION
SECTION B - OVERALL PERFORMANCE
CHECK OVERALL EVALUATION WHICH MUST BE CONSISTENT WITH THE ITEMIZED
RATINGS. ALTHOUGH THERE IS NO PRESCRIBED FORMULA FOR COMPUTING THE
OVERALL PERFORMANCE, ~ WRITTEN COMMENTS ARE REQUIRED TO JUSTIFY
OUTSTANDING OR UNSATISFACTORY RATINGS
D D DOUTSTANDING 480/E
ST4NllARD
STANDARD IW'RDYEMl!NT
N!EDED
EMPLOYEE'S CERTIFICATION:
SJ
D
I REQUEST AN APPOINTMENT TO OJSCUSS THIS RATING WITH MY
DEPARTMENT HEAD.
DUN51TISF4CTORV
1 COORDINATING WORK WITH OTHERS
2 ACCEPTANCE OF RESPONS181LITY
-!...=~=====~=~----+-~--1--i--1--+--1 EMPLOY!E'I SIGNATURE X ~E I J/t"/f/
_.:.;..-=.:;.:;....;...__________-+--+--+-+-+-+--ii"""""';;'(';""~u~"""""'"~'""""""~--~, !~ ~I3 ESTABLISHMENT OF WORK STANDARDS
, TRAINING ANO LEADING STAFF
S PLANNING AND ASSIGNING WORK
6 FAIRNESS ANO IMPARTIALITY TO STAFF
------------------+--+--+-+--+--+--ti RAT!R'& ISIGNATURE X ~:::=::,,.,~ --,0 DATE _.:;;1-"_.0_c...;;,'-"',.;."-''-
7 CONTROL OF STAFF
----------------+--+--+-+--+--+--ti PRINTED NAIIIE/TITL.I!
Jon LifguisUSupervislng Appraiser
8 ADEQUACY OF INSTRUCTIONS
AODITIONAL ITEIIS:
DURING PROBATIONARY PERIOD:
REVIEWER'S 61GNA.TURI!
EMPLOYEE OFF WITHOUT PAY YES 181 NOD PRINTED N4M!/TITLE
IF YES, TOTAL NUMBER OF DAYS WITHOUT PAY: f
REVISED 11/10 1" copy • PERSONNEL 2•• copy • DEPARTMENT 3•d copy • EMPLOYEE

~
DEPT. NO.
I
I
EMPLOYEE NAME IEMPLOYEE Nt
1130 ASSESSOR APPRAISER 1 NASE DANIEL RAYMOND 999025536
REASON FOR RATING RATl~lr. PFR1nn
Special - Increment Advance
C8J D
FROM TO
IF 6-MONTH PROBATIONARY, DO YOU RECOMMEND PERMANENT APPOINTMENT? YESD NOD 12/31/2011 3/12/2012
SPECIAi. SEPARATION
>- >- CHECK OVERALL EVALUATION WHICH MUST BE CONSISTENT WITH THE ITEMIZED
EMPLOYEE'S IMMEDIATE SUPERVISOR SHOULD ...I Cl: RATINGS ALTHOUGH THERE IS NO PRESCRIBED FORMULA FOR COMPUTING THE
CHECK EACH ITEM IN THE APPROPRIATE COLUMN. 0.. <.,
!z 0
OVERALL PERFORMANCE, ~ WRITTEN COMMENTS ARE REQUIRED TO JUSTIFYa. I-
REPORT MUST BE COMPLETED IN INK. ANY
< ~ w u OUTSTANDING OR UNSATISFACTORY RATINGS.
CHANGES MADE IN THE RErORT SUBSEQUENT TO I- 00 ~ ~THE EMPLOYEE'S SIGNING REQUIRE INITIALING BY 0
! er a:
~o
1~~
(/)
D ~ D D DTHE EMPLOYEE AND PERSON MAKING THE z ow
~CHANGES.
(/)
~
z a:0w
~ ~
a. w0 ~w z OUTSTANDING ABOVE STANDARD IMPROVEMENT UNSATISFACTORY
0 0 (/) (/) -Z ::::, STANDARD NEEDED
ALL EMPLOYEES COMMENTS:
1 AITENDANCE X See attached.
2 PUNCTUALITY X
3 PHYSICAL FITNESS X
4 PERSONAL NEATNESS X
5 COMPLIANCE WITH RULES AND REGULATIONS X
6 COOPERATION X
7 ACCEPTANCE OF NEW IDEAS AND PROCEDURES X
8 SAFETY PRACTICES X
t -9 APPLICATION OF EFFORT X N
X
:x :D10 INTEREST IN JOB >
X
..c- n~ ;o rn11 ACCURACY OF WORK Z:-:t.~
rn ...-..:... - 012 QUALITY OF JUDGMENT X ,. ~. (11
rn13 PUBLIC RELATIONS X
Ci'..
n•c'·
""" ,,;;14 WRIITEN EXPRESSION X ~z :x
15 ORAL EXPRESSION X
f ~
016 EQUIPMENT OPERATION X c.n
17 NEATNESS OF WORK X .0
-,4-t..5e> ////'?'7./t::Y~l"Z. 7#,,e .,,,_;~ ~
20 VOLUME OF WORK PRODUCED X -'-~r5pr-/,ivn; ~$~?
22 PERFORMANCE IN NEW WORK SITUATIONS X
23 CUSTOMER SERVICE
~ EMPLOYEE'S CERTIFICATION:
GREETINGS X
HELPFULNESS X
KNOWI.EDGE X
RESPONSIVENESS X
EMPLOYEES WHO SUPERVISE:
2 ACCEPTANCE OF RESPONSIBILITY
3 ESTABLISHMENT OF WORK STANDARDS
4 TRAINING AND LEADING STAFF
5 PLANNING AND ASSIGNING WORK
6 FAIRNESS AND IMPARTIALITY TO STAFF
7 CONTROL OF STAFF
ADDITIONAL ITEMS·
EMPLOYEE OFF WITHOUT PAY YES 0 NO 0
IF YES, TOTl'J.. NUMBER OF DAYS WITHOUT PAY :
REVISED 10/09
~ I HEREBY CERTIFY I HAVE REVIEWED THIS REPORT.
DEPARTMENT HEAD.
f~ ~ -~JnEMPLOYEE'S SIGNATURE ' I ( ~ I ~/1/J.A ,/ ' &I u ~TE 3/,-~Ll:J
'(I UNDERSTAND MY SIGNATURE DOES NOT i:ltCESSARILY MEAN I AGREE WITH ALL THE MARKINGS) '
~
RATER'S SIGNATURE X ' ~
~ DATE 3 /,y//7-
NAME/TITU: Jon Lifguist/Sueeivising Aeeraiser
DATE
'?-lJ-()-
~,-, ••~'"" x ~
NAMemr,E MtE /he;_~~
1
11
copy - PERSONNE
2nd copy - DEPARTMEII
3rc1 copy - EMPLOYE

..
This is a special EPR, Daniel, written in response to your exceptional work on a computer model for
determining market values in specific residential markets. Our current multiple regression analysis has
saved individual appraisers countless hours in estimating ballpark figures for Prop 8 revisions. Your
enhanced and more detailed neighborhood analysis shows dramatic improvement in accuracy resulting in
numbers which I believe would hold up in an assessment appeal.
Specifically, in a short pertod of time, you've achieved the following results:
• Increased the accuracy, (R1) ofthe regression analysis from 77% to 96% in our test market
• An error of less than 5% In each of 104 known sales In the test market.
• A prediction within $1,000 of actual sales price on 15 of the 104 sales, (an average error of less
than .2%)
Factors involved In your success in this endeavor include:
• Your training and proficiency with Microsoft EXCEL and its applications
• Your familiarity with multiple regression analysis
• Persistence and hard work through numerous trial and error attempts at enhancing your
computer model
• Creativity in the application ofknown resources, (adding factors from the Crabtree Report, for
instance)
You've stated that you believe that you can teach the 'Residential staff to create their own regression
analysis and apply it to given neighborhoods assigned to them for review. I expect that having a staff of
Residential appraisers trained in multiple regression analysis should ease the burden of the Assistant
Assessor, who has heretofore taken sole responsibility for creating a countywide computer model, and
though I don't expect to see the near perfect results you've obtained on this limited scale, I believe a
model that is more neighborhood specific could increase the accuracy of many of our Prop 8 reviews.
Additionally, your model helps determine the value contributions of individual property characteristics,
information which can be used for adjustments in individual appraisals or as statistically supported
evidence in assessment appeals.
.Thank you, Daniel, for taking on this task. In addition to working as the highest producer in the Residential
staff for the last several weeks, you've created a model, in a remarkably short time, that could save us
hundreds of hours of time In the Mure. For your contribution, I recommend you for an incremental
increase in pay.
Jon Lifquist
Supervising Residential Appraiser

DEPT. NO.
I
I
EMPLOYEE NAME lEMPLOYEE NO.
1130 ,Assessor APPRAISER2 NASE DANIEL RAYMOND 999-02-5536
REASON FOR RATING ~4T111r. PERlnn
3-MONTH REVIEW
D D
FROM TO
YESD NODIF 6-MONTH PROBATIONARY, DO YOU RECOMMEND PERMANENT APPOINTMENT? 9/22/2012 12/15/2012
SPECIAL SEPARATION
EMPLOYEE'S SUPERVISOR SHOULD ~ ~
IMMEDIATE RATINGS. ALTHOUGH THERE IS NO PRESCRIBED FORMULA FOR COMPUTING THE
CHECK EACH ITEM IN THE APPROPRIATE COLUMN. a. (.') .... 0 OVERALL PERFORMANCE, illCil WRITTEN COMMENTS ARE REQUIRED TO JUSTIFYll. z ....REPORT MUST BE COMPLETED IN INK. ANY
< z w
~
OUTSTANDING OR UNSATfSFACTORY RA TINGS.
CHANGES MADE IN THE REPORT SUBSEQUENT TO .... 0 cc :::E
THE EMPLOYEE'S SIGNING REQUIRE INITIALING BY
i z a: a:
~o 1/l
THE EMPLOYEE AND PERSON MAKING THE ~
~~ ~ ow
~ D D ~ D DCHANGES 1/l
5a)! ~
a: 0LLJ ll. LLJ
8 :11~
z OUTSTANDING ABOVE STANDARD IMPROVEMENT UNSATISFACTORY
0 ~I/) ::::, STANDARD NEEDED
ALL EMPLOYEES: COMMENTS:
1 ATIENDANCE X Daniel, this is your three month review upon being promoted to Appraiser 2. During
2 PUNCTUALITY X this rating period you have continued to be a quality appraiser, turning in large unit
3 PHYSICAL FITNESS X counts with few, if any, errors.
4 PERSONAL NEATNESS X As of now, I have no constructive criticisms or anything in particular that you need
5 COMPLIANCE WITH RULES AND Rl;GULATIONS X to improve on. You appear to be well organized, a,,d to haN'.>your assignment well
6 COOPERATION X under control. ;;,
:n. ~,7 ACCEPTANCE OF NEW IDEAS AND PROCEDURES X You are doing everything asked of an Appraiser .2, and I wn'1ssu~~at you will
8 SAFETY PRACTICES X go above and beyond those duties again if asked to help wethe ~ program.
9 APPLICATION OF EFFORT X
10 INTEREST IN JOB X Thank you for your hard work, and I look forward !!:_orkin~ith ya~ the future.
11 ACCURACY OF WORK X ,;... m.:.:.; .. :..., 012 QUALITY OF JUDGMENT X
".'::'"'" ...:."":.
;Tl -:n
13 PUBLIC RELATIONS X 7'. en·•I
14 WRITIEN EXPRESSION X
16 EQUIPMENT OPERATION X
23 CUSTOMER SERVICE
~ ~ EMPLOYEE'S CERTIFICATION:
GREETINGS X
[81HELPFULNESS X I HEREBY CERTIFY I HAVE REVIEWED THIS REPORT.
KNOWLEDGE X
RESPONSIVENESS X DEPARTMENT HEAD.
EMPLOYEES WHO SUPERVISE:
'~'~""~'~' ~ . l . n fl/~:;{
2 ACCEPTANCE OF RESPONSIBILITY
(I UNDERSTAND MY SIGNATURE DOE:;CESSARILYMEANIAGR~W.RKINGS) I
D~ AW4 TRAINING AND LEADING STAFF
JLLso.)2...5 PLANNING AND ASSIGNING WORK
RATER'S SIQNATURE ~ ... DATE
6 FAIRNESS AND IMPARTIALITY TO STAFF
DA-~lN ~7'11-H-L7 CONTROL OF STAFF
PRINTED NAlo!EITITLE
8 ADEQUACY Of INSTRUCTIONS
,tADDITIONAL ITEMS:
DURING PROBATIONARY PERIOD·
REVIEWER'S SIGNATURE 21;~ ~~ ~ ~ ,1!1~/,z..
c
"'"o"'o""'"o""'' · was D ,oj PRINTED NA>,IE/TITLE Jo" t..:4t...~.lV(1~~<f A~t{,sev-
IF YES, TOTAL NUMBER OF DAYS WITHOUT PAY·
REVISED 11/10 1
11
copy • PERSONNEL 2•• copy • DEPARTMENT 3'" copy • EMPLOYEE

DEPT. NO. I
1130
I
EMPLOYEE NAME IEMPLOYEE NO.
Aaaessor
REASON FOR RATING
6-MONTH REVIEW, ELIG. FOR PERM. APPT.
IF 6-MONTH PROBATIONARY, 00 YOU RECOMMEND PERMANENT APPOINTMENT?
SECTION A - ITE;:MIZED CHECK LIST
EMPLOYEE'S IMMEDIATE SUPERVISOR SHOULD ~
CHECK EACH ITEM IN THE APPROPRIATE COLUMN. C.
REPORT MUST BE COMPLETED IN INK ANY ~
CHANGES MADE IN THE REPORT SUBSEQUENT TO t-
THE EMPLOYEE'S SIGNING REQUIRE INITIALING BY 0
THE EMPLOYEE ANO PERSON MAKING THE Z
CHANGES ~
g
ALL EMPLOYEES:
1 ATIENOANCE X
APPRAISER 2 NASE DANIEL RAYMOND 999-02-5636
RATING PERIOD
YES~ NOD D 3/23/2013
D FROM TO
9/22/2012
SPECIAL SEPARATION
SECTION B - OVERALL PERFORMANCE
RATINGS. ALTHOUGH THERE IS NO PRESCRIBED FORMULA FOR COMPUTING THE
OVERALL PERFORMANCE, ~ WRITIEN COMMENTS ARE REQUIRED TO JUSTIFY
OUTSTANDING OR UNSATISFACTORY RATINGS
D ~ D D DOUTSTANDING ABOVE STANDARD IMPROVEMENT UNSATISFACTORY
STANDARD NEEDED
COMMENTS:
.. ,)
X - -~
X Daniel, this is your 6-month review upon being promoted to an Appraiser2, and I
2 PUNCTUALITY
3 PHYSICAL FITNESS
4 PERSONAL NEATNESS
-X-+--+--ll am recommending you for permanent appointment.
1
'
X As noted in your EPR 3 months ago, I am pleased with your wotjrland yoGr work-
-x--+--ll habits, and I have no constructive criticisms at this point. - ~
5 COMPLIANCE WITH RULES AND REGULATIONS
6 COOPERATION
X You are quietly efficient, and appear to have your assignment well.ynde)~trol.
X Please keep up the good work, and I look forward to working with you in the'future.
7 ACCEPTANCE OF NEW IDEAS ANO PROCEDURES
8 SAFETY PRACTICES
9 APPLICATION OF EFFORT X
10 INTEREST IN JOB X
11 ACCURACY OF WORK X
12 QUALITY OF JUDGMENT X
13 PUBLIC RELATIONS X
14 WRITTEN EXPRESSION X
16 EQUIPMENT OPERATION X
23 CUSTOMER SERVICE ~ I
t----G-RE_E_T-IN_G_S----------~~
HELPFULNESS X
KNO'M..EOGE X
RESPONSIVENESS X
~- ·.:-
EMPLOYEE'S CERTIFICATION:
I REQUEST AN APPOINTMENT TO DISCUSS THIS RATING WITH MY
DEPARTMENT HEAD.
EMPLOYEES WHO SUPERVISE: 'I1 COORDINATINGWORKWITHOTHERS ~ 1.. .A,. 1 .1 '.AA~ A., "2/1~11.12t--~~~-~~----~-----t--t--t--t--+--+---t EMPLOYEE'S SIGNATURE AL,' ' ~b1 .J ,;:ATE , / .I' ~
_2_A_c_c_EP_T_AN_cE_o_F_R_E_s_P_o_Ns_1_s1_L1_TY_____-+-+----+--+--+---+--t <1 UNDERSTAND MY s1GNATURE ooEs N~cesSAR1LY MEAN I AGREE l'IITH ALL THE MARKINGS>' I
4 TRAINING ANO LEADING STAFF
_5_P_LAN_N_IN_G_AN_D_A_s_s_1G_N_IN_G_w_o_R_K_____-+-+----+--+--+---t--l RATER'S SIGNATURE
6 FAIRNESS ANO IMPARTIALITY TO STAFF
_,_c_o_N_TR_O_L_O_F_S_T_AF_F____________--+--+--+---+--1 PRINTED NAME/TITLE
ADDITIONAL ITEMS:
EMPLOYEE OFF WITHOUT PAY YES O NO ~ PRINTED NAME/TITLE
IF YES, TOTAL NUMBER OF DAYS WITHOUT PAY.
REVISED 11/10 1
11
copy - PERSONNEL 2'" copy - DEPARTMENT 3•• copy - EMPLOYEE

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