Dependability Rating. Worker Traits may include: Rater Narrative (optional for rating 1, 2, 3 or 5): Rater Summary Comments (optional) Employee Comments (optional) Employee Signature: Date: Rater Signature: Date: APPENDIX C Portage County Board of Developmental Disabilities CONFERENCE ATTENDANCE REQUEST FORM NAME OF STAFF MEMBER DATES(S) OF CONFERENCE DATE OF REQUEST NUMBER OF WORKING DAYS (HOURS) OF CONFERENCE/MEETING CONFERENCE TITLE CONFERENCE SPONSOR CONFERENCE LOCATION BRIEFLY STATE REASONS(S) FOR REQUEST AND HOW ATTENDANCE WILL BE OF BENEFIT TO THE PROGRAM: INDICATE APPROXIMATE EXPENSES FOR WHICH REIMBURSEMENT IS REQUESTED. (ATTACH CONFERENCE BROCHURE) ESTIMATED COST REGISTRATION FEE $ NUMBER OF MEALS $ LODGING/NUMBER OF NIGHTS $ MILEAGE/NUMBER OF MILES $ OTHER $ EMPLOYEE SIGNATURE DATE SUPERVISOR APPROVAL DATE BOARD ACTION REQUIRED CONFERENCE ATTENDANCE/REIMBURSEMENT APPROVED CONFERENCE ATTENDANCE/REIMBURSEMENT DENIED CONFERENCE ATTENDANCE APPROVED WITH PARTIAL REIMBURSEMENT FOR THE FOLLOWING: SUPERINTENDENT SIGNATURE DATE COPIES DISTRIBUTED TO: EMPLOYEE IMMEDIATE SUPERVISOR BUSINESS OFFICE SUPERINTENDENT 9/1/07 Portage County Board of Developmental Disabilities ALL-PURPOSE LEAVE FORM APPENDIX D NAME BUILDING DATE(S) OF ABSENCE THRU NUMBER OF DAYS (HOURS) TO BE ABSENT If Less Than Full Day: FROM: TO: (CHECK ONE ONLY) ASSAULT LEAVE COURT LEAVE SICK LEAVE (COMPLETE SECTION A) PERSONAL LEAVE UNPAID MEDICAL INCLUDING DISABILITY/MATERNITY/PATERNITY/ADOPTION LEAVE (ATTACH PHYSICIAN'S STATEMENT)(Supervisor detach, send to Administrative Assistant/Human Resource)
Dependability Rating. Worker Traits may include: Rater Narrative (optional for rating 1, 2, 3 or 5): APPENDIX B 2 OF 2 Rater Summary Comments (optional) Employee Comments (optional)
Dependability Rating. Worker Traits may include: Rater Narrative (optional for rating 1, 2, 3 or 5): APPENDIX B 2 OF 2 Rater Summary Comments (optional) Employee Comments (optional) Employee Signature: Date: Rater Signature: Date: APPENDIX C 1 OF 2 Portage County Board of Developmental Disabilities CLERICAL EVALUATION FORM Employee Name Department Job Title Type of Rating: 🞎 Probationary 🞎 Annual Legend: 1= Outstanding 4 = Needs Improvement 2 = Above Average 3 = Satisfactory 5 = Not Applicable Job Responsibilities: (Include brief description job responsibilities):
