**[U.S. DEPARTMENT OF TRANSPORTATION - PERFORMANCE APPRAISAL
FORM]{.smallcaps}**

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| * |                           | ***Social       | ***A     |        |
| * |                           | Security No.*** | ppraisal |        |
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|   |                           |                 | **       | **     |
|   |                           |                 | *From*** | *To*** |
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| * |                           | **              |          |        |
| * |                           | *Organizational |          |        |
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| * | **CERTIFICATION OF        |                 |          |        |
| * | INITIAL DISCUSSION AND    |                 |          |        |
| A | APPROVAL OF PERFORMANCE   |                 |          |        |
| * | PLAN**                    |                 |          |        |
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| * | **MID-POINT PROGRESS      |                 |          |        |
| * | REVIEW**                  |                 |          |        |
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+---+---------------------------+-----------------+----------+--------+
| * | **SUMMARY PERFORMANCE     |                 |          |        |
| * | RATING DETERMINATION**    |                 |          |        |
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| q |                           |                 |          |        |
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+---+---------------------------+-----------------+----------+--------+

**DOT F 3430.9 (3-93)**

**[JOB ELEMENT RATING  ]{.underline}**

\|Check one \|Weight (If required)

\| \|

Job Element No. [1]{.underline} of [5]{.underline} \| [X]{.underline}
Critical Noncritical \| 25%

+-----------------------------------------------------------------------+
| JOB ELEMENT**: Processing personnel actions**                         |
+-----------------------------------------------------------------------+
| **PROFICIENT PERFORMANCE STANDARD:**                                  |
|                                                                       |
| > Independently researches personnel guides to determine correct      |
| > forms, and the information, codes and effective dates for type of   |
| > action requested. Follows up with Team Leader or other requestors   |
| > to fill in missing information on forms submitted by employees or   |
| > supervisors. Determines wage rates for step increases and           |
| > promotions from appropriate pay schedules, using correct procedure  |
| > for type of pay system. Keeps up to date on changes in forms and    |
| > necessary action codes, and periodically reviews regulations and    |
| > personnel guides for changes in processing procedures.              |
| >                                                                     |
| > Personnel actions and forms are generally complete and accurate,    |
| > have no erasures in essential information, meet regulatory and      |
| > processing requirements, and are prepared and submitted to Finance  |
| > or other appropriate office or agency within deadlines; actions and |
| > forms are received by processing office or agency in sufficient     |
| > time that actions do not need to be processed retroactively or      |
| > corrected.                                                          |
| >                                                                     |
| > Retirement packages are submitted for signature with all necessary  |
| > forms and attachments in the order listed on the checklist, and are |
| > sent to Finance within two days of retirement effective date.       |
+-----------------------------------------------------------------------+
| **RATING:**                                                           |
|                                                                       |
| **Distinguished\* Meritorious\* Proficient Needs Improvement\*\*      |
| Unsatisfactory\*\***                                                  |
|                                                                       |
| \*Describe below specific examples of performance above the           |
| Proficient level.                                                     |
|                                                                       |
| \*\*Describe below specific examples of performance below the         |
| Proficient level.                                                     |
+-----------------------------------------------------------------------+

**[EXPLANATION OF PERFORMANCE ABOVE OR BELOW PROFICIENT
LEVEL]{.underline}**

DOT F 3430.9A(3-93) MAC/OST

**[JOB ELEMENT RATING  ]{.underline}**

\|Check one \|Weight (If required)

\| \|

Job Element No. [2]{.underline} of [5]{.underline} \| [X]{.underline}
Critical Noncritical \| 25%

+-----------------------------------------------------------------------+
| JOB ELEMENT: **Recordkeeping**                                        |
+-----------------------------------------------------------------------+
| **PROFICIENT PERFORMANCE STANDARD:** Accurate and orderly records     |
| support the Corporation goal of management accountability by helping  |
| to maintain ISO certification and ensuring adherence to applicable    |
| laws, regulations, and directives.                                    |
|                                                                       |
| OPFs are kept up to date with actions filed as soon as they are       |
| signed; multiple actions, such as pay adjustments for all employees,  |
| are filed within one week after signature. Appraisal forms are filed  |
| in performance folders within two weeks of receipt, medical records   |
| are filed upon receipt, and information is filed in training folders  |
| within one month of receipt. Subject matter files and regulatory      |
| notices are kept up to date within one month of receipt. Ensures an   |
| adequate supply of personnel forms and brochures is on hand; actions  |
| are not delayed because of lack of necessary forms.                   |
|                                                                       |
| Keeps track of suspense dates for such things as step increases,      |
| probationary periods, temporary promotions, etc. Provides reminders   |
| to supervisors or others to ensure deadlines are not missed; step     |
| increases and other suspense actions are processed on time with no    |
| need for retroactive actions or corrections.                          |
+-----------------------------------------------------------------------+
| **RATING:**                                                           |
|                                                                       |
| **Distinguished\* Meritorious\* Proficient Needs Improvement\*\*      |
| Unsatisfactory\*\***                                                  |
|                                                                       |
| \*Describe below specific examples of performance above the           |
| Proficient level.                                                     |
|                                                                       |
| \*\*Describe below specific examples of performance below the         |
| Proficient level.                                                     |
+-----------------------------------------------------------------------+

**[EXPLANATION OF PERFORMANCE ABOVE OR BELOW PROFICIENT
LEVEL]{.underline}**

DOT F 3430.9A(3-93) MAC/OST

**[JOB ELEMENT RATING  ]{.underline}**

\|Check one \|Weight (If required)

\| \|

Job Element No. [3]{.underline} of [5]{.underline} \| [X]{.underline}
Critical Noncritical \| 25%

+-----------------------------------------------------------------------+
| JOB ELEMENT: **Customer Relations**                                   |
+-----------------------------------------------------------------------+
| **PROFICIENT PERFORMANCE STANDARD:** Good customer service supports   |
| the Corporation goal of management accountability by improving        |
| employee morale and helping to retain well qualified, motivated       |
| employees.                                                            |
|                                                                       |
| Provides advice and assistance to employees on such issues as proper  |
| form to use for enrollment or benefit changes, date of next step      |
| increase, and how to fill out forms. Prepares and explains paperwork  |
| to new employees. Employees are provided all applicable forms and     |
| brochures; advice is accurate and timely, and results in proper       |
| preparation of forms, and ensures employees\' rights to benefits are  |
| protected.                                                            |
|                                                                       |
| Mail run and relief for switchboard operator: provides efficient      |
| service; mail is sorted or delivered promptly, calls, visitors and    |
| faxes are promptly routed to the proper office or provided other      |
| assistance, where possible; check register is accurate.               |
+-----------------------------------------------------------------------+
| **RATING:**                                                           |
|                                                                       |
| **Distinguished\* Meritorious\* Proficient Needs Improvement\*\*      |
| Unsatisfactory\*\***                                                  |
|                                                                       |
| \*Describe below specific examples of performance above the           |
| Proficient level.                                                     |
|                                                                       |
| \*\*Describe below specific examples of performance below the         |
| Proficient level.                                                     |
+-----------------------------------------------------------------------+

**[EXPLANATION OF PERFORMANCE ABOVE OR BELOW PROFICIENT
LEVEL]{.underline}**

DOT F 3430.9A(3-93) MAC/OST

**[JOB ELEMENT RATING  ]{.underline}**

\|Check one \|Weight (If required)

\| \|

Job Element No. [4]{.underline} of [5]{.underline} \| [X]{.underline}
Critical Noncritical \| 15%

+-----------------------------------------------------------------------+
| JOB ELEMENT: **Staffing**                                             |
+-----------------------------------------------------------------------+
| **PROFICIENT PERFORMANCE STANDARD:** Support for staffing supports    |
| the Corporation goal of management accountability by ensuring a pool  |
| of well-qualified applicants for positions                            |
|                                                                       |
| Prepares and distributes routine and/or recurring vacancy             |
| announcements, posts announcements to OPMJOBS, prepares MPP folders,  |
| receives and reviews applications for completeness and timeliness.    |
| Ensures requests to use prior applications for temporary promotions   |
| meet two year requirement and ensures each MPP folder has appropriate |
| notations. Generally, MPP actions are posted and processed within     |
| deadlines and meet the requirements in regulations, the Corporation   |
| Merit Promotion Plan, and the Collective Bargaining Agreement.        |
|                                                                       |
| Provides support for DEU activities; keeps DEU files in order;        |
| distributes announcements, assists with receipt of applications.      |
| Ensures an accurate record of receipt of information, information is  |
| filed in accordance with DEU instructions, and is easily retrieved.   |
+-----------------------------------------------------------------------+
| **RATING:**                                                           |
|                                                                       |
| **Distinguished\* Meritorious\* Proficient Needs Improvement\*\*      |
| Unsatisfactory\*\***                                                  |
|                                                                       |
| \*Describe below specific examples of performance above the           |
| Proficient level.                                                     |
|                                                                       |
| \*\*Describe below specific examples of performance below the         |
| Proficient level.                                                     |
+-----------------------------------------------------------------------+

**[EXPLANATION OF PERFORMANCE ABOVE OR BELOW PROFICIENT
LEVEL]{.underline}**

DOT F 3430.9A(3-93) MAC/OST

**[JOB ELEMENT RATING  ]{.underline}**

\|Check one \|Weight (If required)

\| \|

Job Element No. [5]{.underline} of [5]{.underline} \| [X]{.underline}
Critical Noncritical \| 10%

+-----------------------------------------------------------------------+
| JOB ELEMENT: **Computer use/database management**                     |
+-----------------------------------------------------------------------+
| **PROFICIENT PERFORMANCE STANDARD:**                                  |
|                                                                       |
| Uses computer to prepare personnel actions and fill forms for         |
| benefits, and to prepare vacancy announcements and post the           |
| announcements to USAJOBS. Uses internet to ensure office has up to    |
| date information, forms, brochures, etc. on TSP, retirement, life and |
| health insurance. Is proficient enough in database management to      |
| enter and retrieve information, print forms and records as needed,    |
| and to post announcements with OPM within deadlines.                  |
+-----------------------------------------------------------------------+
| **RATING:**                                                           |
|                                                                       |
| **Distinguished\* Meritorious\* Proficient Needs Improvement\*\*      |
| Unsatisfactory\*\***                                                  |
|                                                                       |
| \*Describe below specific examples of performance above the           |
| Proficient level.                                                     |
|                                                                       |
| \*\*Describe below specific examples of performance below the         |
| Proficient level.                                                     |
+-----------------------------------------------------------------------+

**[EXPLANATION OF PERFORMANCE ABOVE OR BELOW PROFICIENT
LEVEL]{.underline}**

DOT F 3430.9A(3-93) MAC/OST