WPC  77WPC >? A7?O@)?N4)?M6w?O?\O?wc=([f<$f^ofZh7>  (  (Untitled)'3,, , ,   UB ) 3    *    d +    d ,    d /0ghjklmnopqrstuvwxyz{|}~P* * f:\inf41\forms\ad435.wpf c:\product\forms\informs\ad435.wpfUS&&&&   >T? f eh Terminal 1 ! ZS  d      Terminal eb Arial " ! <S  d    Arial ez WP IconicSymbolsA  ! x."  d    WP IconicSymbolsA ev Times New Roman  ! <S  d    Times New Roman eh Arrus BT  ! 2L5    d     Arrus BT ex Helvetica-Narrow " ! (5 S  d    Helvetica-Narrow eb Roman  ! 2L   d    Roman eh Helve-WP " ! <S  d     Helve-WP ej Wingdings  ! S  d     Wingdings eX  ! <S  d     eh MS Serif  ! <S  d     MS Serif ed Modern 2 ! x."  d    Modern ej Bodoni-WP  ! <S  d     Bodoni-WP er MS Sans Serif " ! FS  d    MS Sans Serif ed System " ! Z@   d    System e| WPPR Greek Century  ! <S  d    WPPR Greek Century en Courier New 1 ! PL5    d      Courier New er CG Times (WN)  ! <S  d    CG Times (WN) ef Courier 1 ! ZS  d     Courier en Univers ATT " ! FS  d     Univers ATT ep Times CG ATT  ! <S  d     Times CG ATT ep Arial Narrow " ! (5 S  d     Arial Narrow ?(Ad A{?z jV c:\inf41\database\ AD435.DBFHISTORY   i$SSN     h SSN i+PositionNo     h  POSITIONNO i(PayPlan     h PAYPLAN i(OccPlan     h OCCPLAN i%Name  A   h NAMEA i)Paylevel     h PAYLEVEL i)FromDate     h FROMDATE i'ToDate     h TODATE i)OfcTitle  A   h OFCTITLEA i(OrgCode  A   h ORGCODEA i*DutyStatn  -   h DUTYSTATN- i)FundUnit     h FUNDUNIT i'AgyUse     h AGYUSE i'NFCUSe     h NFCUSE i)Element1      h ELEMENT1  i(CrElem1      h CRELEM1  i(T_1[B1]     h T_1_B1_ i(T_1[C1]     h T_1_C1_ i(T_1[D1]     h T_1_D1_ i)Element2      h ELEMENT2  i(CrElem2      h CRELEM2  i(T_2[B1]     h T_2_B1_ i(T_2[C1]     h T_2_C1_ i(T_2[D1]     h T_2_D1_ i)Element3      h ELEMENT3  i(CrElem3      h CRELEM3  i(T_3[B1]     h T_3_B1_ i(T_3[C1]     h T_3_C1_ i(T_3[D1]     h T_3_D1_ i)Element4      h ELEMENT4  i(CrElem4      h CRELEM4  i(T_4[B1]     h T_4_B1_ i(T_4[C1] !    h T_4_C1_ i(T_4[D1] "    h T_4_D1_ i)Element5  #    h ELEMENT5  i(CrElem5  $    h CRELEM5  i(T_5[B1] %    h T_5_B1_ i(T_5[C1] &    h T_5_C1_ i(T_5[D1] '    h T_5_D1_ i)Element6  (    h ELEMENT6  i(CrElem6  )    h CRELEM6  i(T_6[B1] *    h T_6_B1_ i(T_6[C1] +    h T_6_C1_ i(T_6[D1] ,    h T_6_D1_ i)Element7  -    h ELEMENT7  i(CrElem7  .    h CRELEM7  i(T_7[B1] /    h T_7_B1_ i(T_7[C1] 0    h T_7_C1_ i(T_7[D1] 1    h T_7_D1_ i)Element8  2    h ELEMENT8  i(CrElem8  3    h CRELEM8  i(T_8[B1] 4    h T_8_B1_ i(T_8[C1] 5    h T_8_C1_ i(T_8[D1] 6    h T_8_D1_ i)Element9  7    h ELEMENT9  i(CrElem9  8    h CRELEM9  i(T_9[B1] 9    h T_9_B1_ i(T_9[C1] :    h T_9_C1_ i(T_9[D1] ;    h T_9_D1_ i*Element10  <    h ELEMENT10  i)CrElem10  =    h CRELEM10  i)T_10[B1] >    h T_10_B1_ i)T_10[C1] ?    h T_10_C1_ i)T_10[D1] @    h T_10_D1_ i'Exceed A    h EXCEED i&Meets B    h MEETS i)NotMeets C    h NOTMEETS i*TotalRate D    h TOTALRATE i(Outstdg  E    h OUTSTDG  i)Superior  F    h SUPERIOR  i(FullSuc  G    h FULLSUC  i)Marginal  H    h MARGINAL  i(UnAccpt  I    h UNACCPT  i(USDAYes  J    h USDAYES  i'USDANo  K    h USDANO  i)EmplSign L (   h EMPLSIGN( i*ESignDate M    h ESIGNDATE i'EReasn  N    h EREASN  i)SpvrSign O (   h SPVRSIGN( i*SSignDate P    h SSIGNDATE i)RevwSign Q (   h REVWSIGN( i*RSignDate R    h RSIGNDATE i)AprvSign S (   h APRVSIGN( i*AprvSDate T    h APRVSDATE i$PLA U    h PLA i)BonusAmt V    h BONUSAMT i&route W K   h ROUTEK ?^@d @}?Nj^ n 1 Social Security No. SSN!"-./5&67 89: ;>?@ABCG                         P #    d  $      ' --  Y@$.,! *  < && = &&     b^@ n 2 Position Number@ PositionNo!"-./5367 89: ;>?@ABCG                         P #    d  $      '   Y@$.,! *  < && = &&     XF^R n 3 Pay PlanR PayPlan!"-./5@6789:;>?@ABCG                         P #    d  $      '    Y@$.,! *  < && = &&     ]!^ n 4 Occup. Series OccPlan!"-./5G67 89: ;>?@ABCG                         P #    d  $      '   Y@$.,! *  < && = &&     o^$ n 5 Name (Last, First, Middle Initial)$ Name!"-./567(89:(;>?@ABCG                         P #    d  $      ' A  Y@$.,! *  < && = &&     h n 6 Grade/Step or Pay Level Paylevel!"-./5+6789:;>?@ABCG                         P #    d  $      '   Y@$.,! *  < && = &&     ~  n 7 Appraisal Period : !"#      d                       P  &&    Fx n From FromDate!"- ./5:67 89:;>?@ABCG                         P #    d  $      '   Y@$.,! *  <   = &      V!       P    B!x n To ToDate!"- ./5F67 89:;>?@ABCG                         P #    d  $      '   Y@$.,! *  < &  = &     ^,  ( United States Department of Agriculture  2   Performance Appraisal # !"#      d                       P      h^~$ n 8 Official Position Title$ OfcTitle! "- ./567(89:(;>?@ABCG                         P #    d  $      ' A  Y@$.,! *  < && = &&     k~ n 9 Organization Structure Code OrgCode! "-./5+67&89:&;>?@ABCG                         P #    d  $      ' A  Y@$.,! *  < && = &&     _^z  n 10 Duty Stationz DutyStatn! "-./56789:;>?@ABCG                         P #    d  $      ' -  Y@$.,! *  < && = &&     ^l n 11 Funding Unitl FundUnit! "-./56789:;>?@ABCG                         P #    d  $      '   Y@$.,! *  < && = &&     ZD n 12 Agency Use AgyUse! "-./5/6789:;>?@ABCG                         P #    d  $      '   Y@$.,! *  < && = &&     WF4 n 13 NFC Use4 NFCUSe!"-./5@6789:;>?@ABCG                         P #    d  $      '   Y@$.,! *  < && = &&     ^ |X n\ 14  n Performance Elements - !"#                             P  &&     X nQ 15A  n Critical  n Element  ne (T) 0 !"#      Z                       P  &&     X no 15B  n Exceeds  n` Fully  n Successful 8 !"#      Z                       P  &&    x X no 15C  n= Meets  n` Fully  n Successful A !"#      Z                       P  &&    `" X n 15D  n  Does Not  n Meet Fully  n Successful I !"#      Z                       P  &&     V^@       P     Vz&@       P    t&  n Instructions   !"#                             P  &&    & n Blocks 1 through 10, completed by NFC,  n  should be reviewed and, if necessary, corrected.  n Block 11. Enter funding unit number.  n Block 14. Enter brief description of performance elements.  n Block 15A. Check performance elements identified  n  as critical.  $ !"#                             P  &&    5b n Blocks 15B, 15C., 15D. Rate actual performance by entering  n  2 for critical elements and 1 for non-critical elements  n  in appropriate column.  n Blocks 15E, 15F, 15G. Enter total of each column.  n Block 15H. Enter total from 15E, 15F and 15G.  n Block 16A. Check off the correct summary rating described in decision  n  table (16B).  n Blocks 17 through 22. Self-explanatory. + % !"#                             P  &    n^[ nb 1)  !"#                             P      N& p Element1 Element1!"-\./567,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     T 1 T_1#$(a),0-.!/012456789                                    P ! ^"$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"]$%&')*                        Y@$.,!  ( &&     *"^$%&')*                       @$.,!  ( &&     *"_$%&')*                       @$.,!  ( &&     *"`$%&')*                       @$.,!  ( &&     j&      CrElem1#b$%4&'()+,-.                             P   !  *  1  2      3     n^c nb 2)  !"#                             P      8& Element2!"-d./567,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     j&      CrElem2#e$%4&'()+,-.                             P   !  *  1  2      3     ?U?MT 1 T_2#$(g),0-.!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"h$%&')*                        Y@$.,!  ( &&     *"i$%&')*                       @$.,!  ( &&     *"j$%&')*                       @$.,!  ( &&     *"k$%&')*                       @$.,!  ( &&     n^$l nb 3)  !"#                             P      8&$ Element3!"-m./567,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     j$&      CrElem3#n$%4&'()+,-.                             P   !  *  1  2      3     $T 1 T_3#$(o),0-.!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"p$%&')*                        Y@$.,!  ( &&     *"q$%&')*                       @$.,!  ( &&     *"r$%&')*                       @$.,!  ( &&     *"s$%&')*                       @$.,!  ( &&     n^t nb 4)  !"#                             P      8& Element4!"-u./567,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     j&      CrElem4#v$%4&'()+,-.                             P   !  *  1  2      3     T 1 T_4#$(w),0-.!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"x$%&')*                        Y@$.,!  ( &&     *"y$%&')*                       @$.,!  ( &&     *"z$%&')*                       @$.,!  ( &&     *"{$%&')*                       @$.,!  ( &&     n^D| nb 5)  !"#                             P      8&D Element5!"-}./567,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     jD&      CrElem5#~$%4&'()+,-.                             P   !  *  1  2      3     DT 1 T_5#$(),0-.!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"$%&')*                        Y@$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     n^ nb 6)  !"#                             P      8& Element6!"-./567,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     j&      CrElem6#$%4&'()+,-.                             P   !  *  1  2      3     T 1 T_6# $(),0-.!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"$%&')*                        Y@$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     n^d nb 7)   !"#                             P      8&d Element7!!"-./56 7,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     jd&      CrElem7"#$%4& '()+,-.                             P   !  *  1  2      3     ??OdT 1 T_7##$(),0- .!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"$%&')*                        Y@$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     n^ nb 8) " !"#                             P      n^ nb 9) $ !"#                             P      o^ n& 10) & !"#                             P      8& Element8!$"-./56"7,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     j&      CrElem8%#$%4&"'()+,-.                             P   !  *  1  2      3     T 1 T_8#&$(),0-".!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"$%&')*                        Y@$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     8& Element9!'"-./56$7,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     j&      CrElem9(#$%4&$'()+,-.                             P   !  *  1  2      3     T 1 T_9#)$(),0-$.!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"$%&')*                        Y@$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     9& Element10!*"-./56&7,89:;>?@ABCG                         P #      $      '  H  Y@$.,!@ *  < && = <&     j&      CrElem10+#$%4&&'()+,-.                             P   !  *  1  2      3     T 1 T_10#,$(),0-&.!/012456789                                    P ! ^"f$%&')*                       Y@$.,!  ( &&  3 &&    A     ?    ?    ?    ?    ,"$%&')*                        Y@$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     *"$%&')*                       @$.,!  ( &&     o^2@ n 16B (5 !"#                             P  x&&     n Decision Table (check off Summary Rating in block 16A) (2 !"#                             P  &&    9 F n Rating of Outstanding if 15E equals 15H.  n Rating of Unacceptable N/ if any critical element is rated in 15D.  n Rating of Superior if no element is rated in 15D; 15F is greater  n  than zero; and 15E is greater than 15F.  n Rating of Marginal / if 15G is greater than 15E, and no critical  n  element is rated in 15D.  n Rating of Fully Successful if none of the above apply.  )2 !"#                             P  &    $ n N/ Unsatisfactory for SES  n / Minimally Satisfactory for SES .2 !"#                             P  &    W& n 15E Exceeds  Exceed!-"-./586(789:;>?@ABCG                         P #      $      '    @$.,! *  < && = &&     d@sum(T_1[B1],T_2[B1],T_3[B1],T_4[B1],T_5[B1],T_6[B1],T_7[B1],T_8[B1],T_9[B1],T_10[B1])  T_1  T_2  T_3  T_4  T_5  T_6  T_7  T_8  T_9  T_10     k  Tx& n 15F Meets  Meets!."-./5A6(789:;>?@ABCG                         P #      $      '    @$.,! *  < && = &&     d@sum(T_1[C1],T_2[C1],T_3[C1],T_4[C1],T_5[C1],T_6[C1],T_7[C1],T_8[C1],T_9[C1],T_10[C1])  T_1  T_2  T_3  T_4  T_5  T_6  T_7  T_8  T_9  T_10     k  s`"& n 15G Does  n  Not Meet  ^NotMeets!/"-./5I6(789:;>?@ABCG                         P #      $      '    @$.,! *  < && = &&     d@sum(T_1[D1],T_2[D1],T_3[D1],T_4[D1],T_5[D1],T_6[D1],T_7[D1],T_8[D1],T_9[D1],T_10[D1])  T_1  T_2  T_3  T_4  T_5  T_6  T_7  T_8  T_9  T_10     k   V#!       P    o#! n 15H K+ !"#                             P  &&    ??\O{! n 15H Enter total 8+ !"#                             P  &&    " n 15E + 15F + 15G = 15H :, !"#                             P  &&    5#`" TotalRate!0"-./5K6,789:;>?@ABCG                         P #      $      '    @$.,! *  < && = &&     )@sum(Exceed,Meets,NotMeets)   Exceed   Meets   NotMeets    k  Z#  n 16A Summary Rating (See Decision Table in 16B) 8-  !"#                             P  &&x    %4 n Outstanding   Outstdg1#$%;&/'()+,-.                             P   !  * < 1  2      3     %4 n Superior   Superior2#$%;&0'()+,-.                             P   !  * < 1  2      3      &4 n Fully Successful   FullSuc3#$%;&1'()+,-.                             P   !  * < 1  2      3     t'4 n Marginal /   Marginal4#$%;&2'()+,-.                             P   !  * < 1  2      3     <(4 n Unacceptable N/   UnAccpt5#$%;&3'()+,-.                             P   !  * < 1  2      3     6) n N/ Unsatisfactory for SES  n / Minimally Satisfactory for SES ;4 !"#      n                       P  &    ^%2 n 17 Employee (Check off appropriate box) 05 !"#                             P  <&    6^H&X n I have a copy of USDA and Agency regulations on employee responsibilities  n and conduct; I have discussed them with my supervisor and questions have  n been answered to my satisfaction. 1( !"#                             P  <&&    H&  n Yes   USDAYes6#$%*&1'()+,-.                             P   !  * < 1  2      3       @RESETOBJ (USDANo)   USDANo    t'  n No   USDANo7#$%*&2'()+,-.                             P   !  * < 1  2      3      !@RESETOBJ (USDAYes)    USDAYes    ^(2 n 18 Employee's Signature 45 !"#                             P  <&    ^0* n (Instructions for resolutions of disputes are on the reverse of employee copy.) 6, !"#                             P  <&     V (,       P    j (^ n Date 4 !"#                             P  &&    (^ n If employee did not sign, state reason. &4 !"#                             P  &&    2^6)T  EmplSign!8"-./564789:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < && = &&     5 6) ESignDate!9"-./5647 89:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < && = &&     0h) EReasn!:"-./5&65789:;>?@ABCG                         P #    Z  $    Z  '  (  Y@$.,!d *  < && = &&     `^*+   n 19 Supervisor's Signature SpvrSign!;"-./567789:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < <& = &&      V *+,       P    M *+x  n Datex SSignDate!<"-./5677 89: ;>?@ABCG                         P #      $      '   Y@$.,! *  < && = &&     ^*+t  n 20 Reviewer's Signaturet RevwSign!="-./5'67789:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < <& = &&     M!*+x  n Datex RSignDate!>"-./5F677 89: ;>?@ABCG                         P #      $      '   Y@$.,! *  < && = &&      V!*+,       P    ^J.N  n 21 Approving Official's or Funding Unit  n  Manager's Signature (optional)N AprvSign!?"-./56;789:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < <& = &&      V J.,       P    M J. n Date AprvSDate!@"-./56;7 89: ;>?@ABCG                         P #      $      '   Y@$.,! *  < && = &&     {J. n 22 FOR SES ONLY ';* !"#                             P  <&<    Dv/  p PLA PLA!A"-./506<789:;>?@ABCG                         P #      $      '    Y@$.,! *  < && = &&     :f!v/ BonusAmt!B"-./5G6<7 89:;>?@ABCG                         P #      $      '     $.,! *  < && = &&     ov/, n PLA to ES +< !"#                             P  $    rFv/L, n Bonus Amount @<  !"#                             P  $    z j1 ni Form AD-435 (11/86) F?  !"#                             P  &&    v81h  d This form was electronically produced by Elite Federal  d Forms, Inc. /? !"#                            <  &<&    81xQ ( Print Form print  C ;?  !"#$%           &&     @setvalue(route,"Original -- NFC Processing Copy",true);@printdlg();@setvalue(route,"Copy 1 - Official Personnel Folder/Employee Performance File",true);@printdlg();@setvalue(route,"Copy 2 - Employee Copy (Employee Appeal Rights On Reverse)",true);@printdlg();@setvalue(route,"Copy 3 - Supervisor Copy",true);@printdlg();@setvalue(route,"Copy 4 - Agency Use",true);@printdlg();@resetobj(route)&   route 6  Original -- NFC Processing Copy              route S  Copy 1 - Official Personnel Folder/Employee Performance File              route Q  Copy 2 - Employee Copy (Employee Appeal Rights On Reverse)              route /  Copy 3 - Supervisor Copy              route *  Copy 4 - Agency Use              route    ??wHw^1 q& route route!D"-./56?7,89:;>?@ABCG                         P #      $    d  ' K  Y@$.,! *  < && = &&     ?=(defg h =O<$defg <^o elite10.DLL IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. elite10.COM IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. WPIN$ELITE10FunctionSet,4.1 ^=ZM\RZx