This performance evaluation rates Derek Folley, a clerk in the County of Los Angeles Department of Public Social Services, as "Competent" for the evaluation period of April 1, 2008 through September 30, 2008. The evaluation finds that Mr. Folley meets expectations in productivity, quality of work, work habits, personal relations, adaptability, job knowledge, and communication skills. Supplemental documentation provides examples of Mr. Folley's duties as a stockroom clerk and notes his training, punctuality, organization, and willingness to help others. Overall, the evaluation determines that Mr. Folley has demonstrated the potential to be an asset to the department.

1. 5
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County of Lo-:> Angeles • Department of Public Social Services
Performance Evaluation
PROBATIONARY IIIIIIIIIIIIIIIIII~IIIIII~1~111I11I~lImllllllli
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Employee Name Employee Number 535486 Item Number 1136DEREK FOLLEY
Position
Period: From Apr 1, 2008 Through Sep 30, 2008CLERK
Dept. Div. P/L Status PERM IDue Date Aug 30, 2008140 737 H1
INSTRUCTIONS
1. Indicate on Page 2, with the following symbols, whether the employee meets the Departmental expectation (,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:
IN =improvement ~eeded C =~ompetent U = jJnsatisfactory
4. In the Overall Rating section below, check the appropriate rating.
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.
IMPROVEMENT NEEDED: The probationer is not progressing at a rate commensurate with his/her time, training and experience on the job. If he/she does
not achieve specific goals by the time specified in the report, he/she will not pass probation.
COMPETENT: Work performance is equal to or above the requirements of the position. This rating carries with it the appointing authority's approval to make
the appointment final and complete.
UNSATISFACTORY: The employee's performance is below performance requirements for the position. Factual evidence must be presented in writing to
substantiate this rating, which carries with it the appointing authority's decision not to approve final and complete appointment. If permanent employment is
recommended, no factor should be assigned this rating.
OVERALL RATING FOR EVALUATION PERIOD RECOMMENDATION TO DEPARTMENT HEAD
1ZI Ido
Recommend nd complete apPOlntm~nt
o IMPROVEMENT NEEDED-INTERIM ONLY
.
o I do not r I[Z] COMPETENT
RATER'S SIGNATURE ATE
Z-!l ~ ~
o UNSATISFACTORY [Z] I do
,-REVIEWER'S SIGNATURE
o ~PX;'PPOi"'1f1. f (V
DATE
USE WHEN PROBATIONARY PERIOD NOT COMPLETEACTION OF DEPARTMENT HEAD
I concur with, and approve this report of performance evaluation. o Failed medical examination DATE _
On the basis of this report:
DATE _o Resigned from County Service
o
[l] I approve final appointment.
I do not approve final appointment, and request the commission's
o Left position to accept another
DATE _consent to: County position
o Reduce the probationer to the position of
o Discharge the probationer from service.
(Effective date of action)
DATE _Copy of report to employee:
given/mailed
DEPT. HEAD };.< ("J.Jnt J- DATE cr "'J.,-~rI Address:
(or authorized representa~----
DATea8 AuG 08 IBy
Copy of report given DATE 09-03-08
given/mailed
By Manoosh Mehrabian
Filing instructions:
Competent PE - Original to Central Personnel Folder; One Copy to Office Personnel Folder; One Copy to Employee.
Unsatisfactory PE - Original to Central Personnel Folder; One Copy to CAO; One Copy to Office Personnel Folder; One Copy to Employee.
PA 21.18 (Rev. 03/06) Page 1 of 3
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2. 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 overall rat­
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.
Employee
Signature: /~V I U'" ~
Date: ~C
y of this page.
Rater
Signature: ;;so L.!V v,;. ­ J. ..>­ ....... - - -.
Date: ==-s-z=,...... , ...... y
, I
Page 2 of 3
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3. CO!lnty of toos Angeles Jepartment of Public Social Services
Performance Evaluation
PROBATIONARY
Through Sep 30, 2008
DEREK FOLLEY
COMMENTS (Required)
Rating Factor
Discuss the employee's performance, giving examples to support
your ratings. If he/she has functioned in an Acting position duringj[De~rtmentalExp.clatlon.
the rating period, please discuss his/her performance in that
1. Productivity: _ iel capacity. Attach extra pages if needed.
e-..=..-J
mAmount of work performed
[±J Completion of work on schedule See attached.
i-Cl2. Quality:
1Zl Demonstrates accuracy and thoroughness
[±J Applies feedback to improve performance
o Edits and proofreads own work
1Zl Writes clearly, concisely, and legibly
3. Work Habits: _ L£;
[Z] Observes organizational programs, policies, and
procedures
[±J Plans and organizes work
mMeets attendance requirements
[±J Observes working hours
[Z] Sets appropriate priorities
[Z] Shares knowledge with others
[Z] Complies with instructions
[Z] Meets deadlines
4. Personal Relations: @J
mRepresents the Department in a professional and
effective manner
[±J Practices cooperation and teamwork
[Z] Exhibits consideration in interactions with others
[Z] Responds promptly to inquiries
ill Exhibits appropriate personal appearance and
conduct
ill Works effectively with all levels of staff
5. Adaptability: [~J
ill Adapts to changes in the work environment
1Zl Performs effectively in new situations
[Z] Performs effectively in emergencies
1Zl Performs effectively with minimum instructions
6. Job Knowledge: _ I -Cl
._-1
[Z] Adheres to program policies and procedures
[±J Demonstrates required job skills
[Z] Understands relevant computer systems
[Z] Makes appropriate use of training resources
7. Communication Skills: [Cl
m Provides prompt and courteous customer service
[Z] Maintains open lines of communication with all
levels of staff and community
[Z] Is able to impart negative information in a
courteous and respectful manner
PA 2118 (Rev. 03/06) Page 3 of 3
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4. County of Los Angeles Department of Public Social Services
Performance Evaluation
(Supplemental Sheet)
Probationary
TYPE OF PERFORMANCE EVALUATION
EMPLOYEE NAME:
DEREK FOLLEY
POSITION:
CLERK
EMPLOYEE NUMBER:
535486
DEPT.
140
DIV.
737
P/L
H1
PERSONAL RELATIONS
ITEM NUMBER: DUE DATE:
1136 Aug 30, 2008
RATING PERIOD
From: Apr 1,2008 Through: Sep 30, 2008
Mr. Folley represents the Department in an effective and efficient manner. He gets along with all levels of staff.
He assists when help is needed. He is always a gentleman and conducts himself in a professional manner.
His appearance is neat and meets the Department's standards.
ADAPTABILITY
Mr. Folley adapts well to changes and perfonns well in emergencies. He completes his assignments in an
efficient and timely manner with minimal instructions.
JOB KNOWLEDGE
Mr. Folley continues to gain knowledge in the clerical support unit. He is knowledgeable ofthe LEADER
computer system and utilizes it for the completion of his work assignments. Mr. Folley demonstrates the
required job skills necessary to perfonn his duties. Mr. Folley has worked overtime to help process Medical
Redetennination documents.
COMMUNICATION SKILLS
Mr. Folley maintains an open line of communication with all levels of staff. He is courteous and respectful
to staff, and maintains a professional manner at all times.
Mr. Folley demonstrates the potential to be an asset for the Medi-Cal District and to the Department.
Mr. Folley's overall perfonnance as a Clerk for this evaluation period is rated "Competent".
SIGNATURES:
DATE:Jvg
EMPLOYEE:
RATER:
REVIEWER:
DATE:
DATE:
DATE:
Cf- ~. tJ P
PA 223 (Rev. 03/06)
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5. County of Los Angeles Department of Public Social Services
Performance Evaluation
(Supplemental Sheet)
Probationary
TYPE OF PERFORMANCE EVALUATION
f;:MPLOYEE NAME:
DEREK FOLLEY
POSITION
CLERK
EMPLOYEE NUMBER:
535486
DEPT
140
DIV.
737
P/L
H1
ITEM NUMBER: DUE DATE:
Aug 30, 20081136
RATING PERIOD
From: Apr 1,2008 Through: Sep 30, 2008
Mr. Derek Folley is a newly hired clerk assigned to Hawthorne Medi-Cal Regional District on April 01, 2008.
Mr. Folley's job assignment is the Stockroom. Mr. Folley's duties as the Stockroom Clerk are to process supply
order requests for each unit weekly, take inventory of supplies, organize and, keep accurate records of all supplies
in the stockroom, unload incoming district supplies, and stock them in their proper place, pack unused supplies to
be sent to MMS warehouse. Mr. Folley has received several training on clerical procedures including:
processing of mail, unit coverage, transfer desk, filing, and assisting the Medi-Cal Redetermination Unit and
Administrative Staff.
PRODUCTIVITY
Mr. Folley meets the standard of processing his work assignments. He completes his job tasks in a professional
timely manner.
QUALITY
Mr. Folley is able to complete his work assignment accurately. He takes time to review his work carefully for
errors. Mr. Folley applies guidance received in order to process his daily work assignments.
WORK HABITS
Mr. Folley's observance of working hours meets the Departmental attendance standard. In addition, he gives
notification of scheduled appointments. Mr. Folley observes the rules and regulation of the Department's policy.
He reports to his workstation on time and leaves on time. He is prompt when taking his lunch and breaks. He
complies with instructions and willingly shares his creative knowledge with all levels of staff. Mr. Folley has
very good organizational skills and is able to set priorities.
SIGNATURES:
DATE:
PA 223 (Rev. 03/06)
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