CONTOH FORMULIR PENILAIAN

PT. ADMIRAL FORMULIR PENILAIAN KARYAWAN Lembar [1]

JAKARTA PERIODE : ….. / ….. / ….. s/d ….. / ….. / …..

DATA KARYAWAN:
N A M A : .…………………………………………………… JABATAN: ……………………...........
TGL.MASUK KERJA: ……. / ……. / ……… PENDIDIKAN TERAKHIR: …………………………...

DATA ABSENSI:
1. S A K I T : [ ….. hari x (-0,5)] + [ ….. hari x (-1)] = ……}
2. I Z I N : [ ….. hari x (-0,5)] + [ ….. hari x (-1)] = ……} NILAI ABSENSI (NA) = (--)
3. MANGKIR : [ ….. hari x (-1,0)] + [ ….. hari x (-2)] = ……} (1+2+3)

No. KRITERIA PENILAIAN NILAI KETR.

01. KEJUJURAN
02. LOYALITAS
03. KREATIVITAS & KECERDASAN
04. WAWASAN
05. BERANI MENGAMBIL KEPUTUSAN
06. BERPIKIR & BERTINDAK SISTEMATIS
07. KETEGASAN
08. DISIPLIN
09. CEKATAN / GESIT
10. PEDULI & RESPONSIF
11. TIDAK SUKA MENUNDA WAKTU
12. KETELITIAN DALAM BEKERJA

NB: Nilai = 1 s/d 5 (lihat Panduan Penilaian Karyawan) NILAI TOTAL (NT) : *****
NILAI FINAL (NF) = (NT) – (NA) = ( …….. ) – ( .……. ) =
*****
REKOMENDASI : 1. PROMOSI JABATAN 2. PROMOSI DIKLAT 3. DIPERTAHANKAN
(lingkari yang dipilih)
4. REWARD/BONUS 5. PROMOSI GAJI 6. MUTASI 7. DIGANTI

Jakarta , ………………………20….
KARYAWAN PENILAI

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NB: Distribusi lembar [1] Departemen SDM, [2] Arsip Penilai.

UKM“SEJATI” FORMULIR PENILAIAN KARYAWAN

PERIODE : ..... / ..... / ..... s/d ..... / ..... / .....
N A M A : ..................................................................... Bagian : ..................................
ABSENSI : 1.Sakit 2.Izin 3.Mangkir
REKOMENDASI : ..................................................................................................................................
..................................................................................................................................
No. KRITERIA PENILAIAN NILAI KETR.

1. KEJUJURAN
2. LOYALITAS
3. D I S I P L I N
4. TIDAK SUKA MENUNDA WAKTU
5. TELITI DALAM BEKERJA
6. .........................................................
7. .........................................................

REKOMENDASI : .........................................................................................................
TABEL RANGKUMAN PENILAIAN
...........................................................................................................................................
PT. ADMIRAL Lembar [1]
SEKSI / BAGIAN : ………… /………….
...........................................................................................................................................
JAKARTA
PERIODE : …. /…. /…. s/d …. /…. /….
Jakarta, ............................................
NILAI SESUAI NOMER KRITERIA
No. KARYAWAN
NAMA KARYAWAN PENILAI TOTAL
01 02 03 04 05 06 07 08 09 10 11 12 NILAI

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Jakarta, …………………………

ATASAN PENILAI PE N I LAI

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NB: Distribusi lembar [1] Departemen SDM, [2] Atasan Penilai, [3] Arsip Penilai.