Fillable Printable VA Form 4667b
Fillable Printable VA Form 4667b
VA Form 4667b
SUPERVISORY APPRAISAL OF EMPLOYEE FOR PROMOTION
SPECIALIZED CATEGORY APPRAISAL WITH NARRATIVE
NAME OF EMPLOYEE PRESENT POSITION AND GRADE CURRENT ORGANIZATION
ANNOUNCEMENT NO.
POSITION APPLIED FOR (Title and grade)
ORGANIZATION LOCATION OF POSITION
INSTRUCTIONS: The information furnished on this form will be important in determining the
degree to which the employee possesses the Knowledge, Skills, Abilities, and Other characteristics
(KSAO's) which are required for performance in the position being filled. In Column II below, the
supervisor and/or reviewer will indicate beside the Rating Factor (KSAO) or Job Element listed in
Column I, the number of the Category Rating (0 to 5) which best describes the employee's
performance with respect to the Rating Factor (KSAO) or Job Element. If the employee's current job
does not include any of the KSAO's in the Rating Factor or Job Element and, therefore, performance
in them has not been observed, mark "0". In Column III, for each Rating Factor or
Job Element, give specific examples which show how the employee's performance justifies the
Category Rating assigned. If more space is required, use additional sheets of paper and include the
name of the supervisor at the top of each sheet and identify the appropriate Rating Factor or Job
Element. NOTE: This form may be used for comments by the supervisor followed by those of the
reviewer or separate forms may be used for each. If separate forms are used for the supervisor and the
reviewer, the supervisor's appraisal should be made available to the reviewer during the review
process.
CATEGORY RATINGS
Employee's performance exceeds expectations to such an extent that it warrants special mention
for placement consideration.
5
4
Employee has demonstrated the Rating Factor (KSAO) or Job Element to a degree that is clearly
above that expected of a fully competent employee and you would expect the employee to display
the same degree of ability in the position applied for.
3
Employee has demonstrated the Rating Factor (KSAO) or Job Element to the full extent expected
of a thoroughly competent employee and you would recommend the employee with confidence for
another position in which the Rating Factor (KSAO) or Job Element is important.
2
Employee's performance relative to the Rating Factor (KSAO) or Job Element is acceptable but
you would have some reservations about recommending the employee for another position in
which the Rating Factor (KSAO) or Job Element is important.
1
Employee's performance relative to the Rating Factor (KSAO) or Job Element exhibits some
definite weaknesses.
0
Unable to appraise (When this category is used, cite reasons - e.g., current job does not include
the KSAO's in this Rating Factor or Job element.)
COLUMN I
RATING FACTOR (KSAO) OR JOB ELEMENT
COLUMN III
NARRATIVE: Specific examples of what the employee has or has not done to cause me to ward this rating.
COLUMN II
CATEGORY
VA FORM
MAR 1992 (R)
4667b
COLUMN I
RATING FACTOR (KSAO) OR JOB ELEMENT
COLUMN II
CATEGORY
RATING
COLUMN III
NARRATIVE: Specific examples of what the employee has or has not done to cause me to ward this rating.
VA FORM 4667b MAR 1992 (R)
2
COLUMN I
RATING FACTOR (KSAO) OR JOB ELEMENT
COLUMN II
CATEGORY
RATING
COLUMN III
NARRATIVE: Specific examples of what the employee has or has not done to cause me to ward this rating.
SIGNATURE OF SUPERVISOR DATE TOTAL TIME YOU SUPERVISED EMPLOYEE
FROM TO
SIGNATURE OF REVIEWER DATE
TOTAL TIME EMPLOYEE UNDER YOUR DIRECT OR INDIRECT SUPERVISION
FROM TO
SIGNATURE OF EMPLOYEE (If appropriate) DATE
VA FORM 4667b MAR 1992 (R)
3
CONTINUATION SHEET
VA FORM 4667b MAR 1992 (R)
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